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OVAL'11 COUnl}y��7410 Co. Rd. K, No. 402, Siren, <br /> �Y Wf 54572 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N K <br /> C ` <br /> OWNER TELEPHONE <br /> HOME ADDRESS i" a` �° 9 <br /> r m <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) L C)T a <br /> DWELLING/BUILDING GARAGE/ACCESSORY <br /> TYPE OF PERMIT(S): STRUCTURE ❑ ADDITION ❑ PRIVY ❑ N <br /> � <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> 5. <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: �c,��� ,�yt� 2. <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 71 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O CD <br /> m a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T Z <br /> v t <br /> 2. $HOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). C 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 1 v <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. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO o <br /> BUILDINGS,ROADS, LAKE,LOT LINES. <br /> S. INpICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 64 <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. c ) <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN5 0, <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z .. <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. _ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. S I" Cb CP <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFI LLY <br /> PERMITTED. J <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN TH R �l <br /> SETBACK AREA. f tem lJ <br /> 5. AiaN Gjfh#&44 L11C m 62 IM044 <br /> , � -VO� a 0 .0 <br /> s. ., �. 7a 6e �ol��oa/ �,4k�s�d� G�a� 'Jll� _ . i a e o'- z <br /> i wa <br /> " `o : _� � <br /> co <br /> I declare that this application (including any accompanying schedule) has been examined the be my C p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsibl curacy of a, t= <br /> all Information contained in this application(incl Ing any accompanying schedule)and I further re that recognize (D m <br /> that this information I am providing will be relied Pon by the County of Burnett Wisconsin in determining whether to is- p <br /> sue a permit. I further accept all liability which y be a result of the County of Burnett relying on this information I am m <br /> providing in this application. I agree to permit unty officials charged with administering county ordinances or other o ' <br /> authorized perso have access to the above d cribed premises at any reasonable time for the purpose of inspection. <br /> iCD <br /> m : <br /> CD <br /> SIGN HERE <br /> (sig ur of owner uil ' g contractor) (date) <br /> ZONING ADMINISTRATOR <br /> Ln <br /> L <br /> wv.Fnww <br /> N N (l N N N t n I n <br /> (J1 N O VI Ir O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />