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GLayv <br /> County 7410 Co. Rd. K, No. 102, Siren,WI 64872 Office of Zoning Administrator - c o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N <br /> N <br /> cc' 1 /G 0 <br /> /t-eR y �� (� J TELEPHONE <br /> r � m <br /> /� `/ a O <br /> HOME ADDRESS 5070 =E'^ ✓AF1C ( Mo Nd�S Y j 5-W MAI SS 1�2i CD <br /> r 1 <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME W,51- aRSS LAkir kj, .. <br /> 01A--3 311733.3 (o06171V9 PCS Gey ' ' 3 <br /> LEGAL DESCRIPTION (see tax receipt)S y Ty yV *ROS / 2��" '�'/ _d O$8vc� V C <br /> DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ElADDITION 1:1 PRIVY LJ Cn 0� <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAM ING UNIT ❑ SUBDIVISION El5 <br /> STRUCTURE/ADDITION USE: NOo"E ca-AIAI 0 <br /> f� (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) m <br /> BUILDING CONTRACTOR: <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O = <br /> � W o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 M <br /> ?� O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE im <br /> NORTH(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 S7 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. t <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. r NQj <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 /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 0 1 <br /> CONDITIONS OF PERMIT: IO Q <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT SuS <br /> ISSUANCE. \\\ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. GOO <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. qj <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> �l d im M. md�� O <br /> m <br /> 6. huh umora of 1� 9 M R -aON N <br /> . <br /> 7. �ffV4 SIM c m �� <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize : C <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 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 <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. m <br /> - <br /> m <br /> SIGN HERE _ (signature f owner or building contractor) (date) <br /> ZONING ADMINISTRATOR 4 <br /> N NN NN 010 <br /> (n (J1 0(n Ill 0 0 <br /> O 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0000000 <br />