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13Wnett C aunty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Z ning Administrat - o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N 0� <br /> CD <br /> OWNER RN <br /> j � / c C <br /> G & O V 41 !qP^ TELEPHONE 6- /,2-s0p n'd 0 3 -2 O n w <br /> m <br /> HOME ADDRESS 0 (�/ �� RD 6L,nrAi1 M .. <br /> r � <br /> EMERGENCY/FIRE NUMBER ROAD NAME I <br /> y29 ps X119/fsq <br /> flltol v R/dw/ a .(es ! 3Q Q L <br /> LEGAL DESCRIPTION(see tax receipt) �C(O� (^ 1 0 OZ`j D O �a�O ZZs `hA �P��S ¢ <br /> �TCs77•��_ ' � <br /> � W <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ <br /> TYPE OF PERMIT(S): �� �o �; <br /> FILLING/GRADINGG'`❑ CAMPING UNIT ❑2SUBDIVISION <br /> ❑ A 5 <br /> STRUCTURE/ADDITION USE: (�IP�{ 9e �� X JCJ rqe. l � ��/� o <br /> (Home/Cabin;'Commercial Business; Be om; Deck;etc.) u1 <br /> L F <br /> BUILDING CONTRACTOR: Se <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 3 <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O'n Z a O' <br /> 1 .ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m IF <br /> NORTH(N). <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO M <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO <br /> BUILDINGS,ROADS,LAKE, LOT LINES. J" <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> m ooF , <br /> O 9 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN a o <br /> NEEDED. a <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z lwt11 <br /> CONDITIONS OF PERMIT: o I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. u , <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. A 1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY rr''11 n <br /> PERMITTED. vV <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THTEQUIREDAER `�yj <br /> SETBACK AREA. \ <br /> 5. I (qMl J► <br /> �f 1 \ rn <br /> 6. \ ;o v 0 , H MO <br /> '7. Y o zm <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c ID <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> v t: <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ;am m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- t7 <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am JL; <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. T <br /> Q p N <br /> SIGN HERE � p iG✓ �/2 / <br /> (signature of own1gr orbuildi g contractor) (date) <br /> ZONING ADMINISTRATOR w <br /> wwcnuww� <br /> N NInNN (]1 f11 <br /> V7 NOUI U 00 <br /> TOWNSHIP PERMITS AY BE REQUIRED /v 0 C)CD C) 0 0 o <br />