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Surnett County 7410 Co. Rd. K, No. 102, Siren, <br /> WI 54872 Office of Zoning Administrator � � Z <br /> APPLICATION FOR LAND USE PERMITS 3 4 0 <br /> T <br /> N <br /> C <br /> OWNER <br /> A&A-'L'o TELEPHONE m W <br /> n <br /> HOME ADDRESS Parc f / Z) <br /> � a <br /> EMERGENCY/FIRE NUMBER ROAD NAMECC' <br /> f <br /> LEGAL DESCRIPTION (see tax receipt) Le �S_ �S A� y <br /> v`� e <br /> C'DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ cao <br /> TYPE OF PERMIT(S): C <br /> Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDSION <br /> S. <br /> �7/ <br /> STRUCTURE/ADDITION USE: L- N' <br /> o <br /> (Home/CabCommercial Business; Bedroom; Deck;etc.) y <br /> #� <br /> BUILDING CONTRACTOR: CD <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. T 3 <br /> O <br /> j N <br /> DIRECTIONS FOR PLOT PLAN DRAWING• (AERIAL OR TOP VIEW) 0 <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2 SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m n <br /> O <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. � c <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO �tl <br /> BUILDINGS,ROADS,LAKE, LOT LINES. 141* <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 �o T ' <br /> MUST BE SIGNED AND DATED BY THE OWNER. S <br /> 0- 9 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o, V J <br /> NEEDED. r <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT d <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY r <br /> PERMITTED.' <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK A,� ^� <br /> 5. //`1` �j h <br /> svar- oeov <br /> 6. m �. 3 c m a m <br /> 9 N C N U <br /> 7. Z : 0 m� 0 <br /> o XI <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m C) : C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m ': m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- E E E O <br /> d <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 -1ZS <br /> providing in this application. I 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. r <br /> CD <br /> SIGN HERE y�a ca ;ca i�. �c• /O /I —�� e+ 3 <br /> (signature of caner or building c ractor) (date) <br /> ZONING ADMINISTRATOR <br /> N NUI N NtT ut <br /> UI UI O UI UI O O <br /> TO NSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />