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,gin GIC7� <br /> B►urnett�`County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator (D o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> m o <br /> c <br /> L ��''` TELEPHONE( / /�� J ^p <br /> OWNER IJA YMQ. -1}-Jve USLCLN� \� S� TS3-3f,6 <br /> '1 z fD O� <br /> HOME ADDRESS d, 3 J ��3, /9,bepjeSS�,j� (c� <br /> 0 <br /> EMERGENCY/FIRE NUMBER a g �? ROAD NAME 3-0 ,VSc N Latae Rd. t <br /> LEGAL DESCRIPTION (see tax receipt) L.D Ol�m y y O 6.0 v r rf c <br /> SCc uN / pp yc ` ` <br /> DWELLING)BUILDING RAGE ESSORYTRUCTURE ADDITION IVY ❑ N <br /> c <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ S. <br /> STRUCTURE/ADDITION USE: L 1 r l"^t S.P4c('? 3 <br /> (Home/Ca ; Commercial Business; Bedroom;Deck;etc.) m <br /> BUILDING CONTRACTOR: ke C?5 Luno 0O1L:;-t l `yam 6' <br /> vJ? <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. x N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n n 0 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m W M <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C \ n <br /> NORTH(N). y (� ° <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v� a <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ° <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <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 /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ? i <br /> CONDITIONS OF PERMIT: (\, <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT �J <br /> ISSUANCE. xJ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. t1alla-Wt 3 ; = d F m <br /> 3a FIM. <br /> 6. � CDC1i !' � � 3 <br /> @ W O f° <br /> Z : < <br /> 7. c ` ` '1—m ? ' M <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G� IS <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of d n E <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- �U m <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 E m E <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other <br /> CD <br /> authorized person toihave accessA0 the above described premises at any reasonable time for the purpose of inspection. <br /> m : <br /> :Z4 <br /> SIGN HERE <br /> o(sinatureqoflownerorbu ng contractor) (date) <br /> c <br /> ZONING ADMINISTRATORj06' <br /> N NulNM <br /> °1NONO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 <br />