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M6CO <br /> turnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator CD- o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> O <br /> C W <br /> {�/ n <br /> OWNER �a� T (� //✓� TELEPHONE O�rl�-7Zy7 d <br /> HOME ADDRESS <br /> 0 m <br /> EMERGENCY/FIRE NUMBER ROAD NAME Aw 9040 . ) <br /> o9/T38/R/Sti1 �yC'2E5 DoT2C`S,c( PAV2 <br /> LEGAL DESCRIPTION(see tax receipt) 2-3�— /S"Q�/— O 0330p �/Nlj'o41/aT.SJ m <br /> 0 <br /> Q <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ y <br /> c � <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ CL n <br /> STRUCTURE/ADDITION USE: ("44/A) � <br /> (Home/Cabin; Commercial Business; Bedroom;Deck; etc.) U <br /> BUILDING CONTRACTOR: e/ -F <br /> M <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR�rj m 3 n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. x mewa <br /> �J <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n <br /> o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m �M <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C <br /> NORTH(N). Cn <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m p <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. P <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. 1 0 � <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 3. <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> v � I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> S �J <br /> NEEDED. <br /> z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. P -1Z <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT �� _ C> <br /> ISSUANCE. 11 <br /> ISSUANCE. W <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ' <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY p, <br /> PERMITTED. �I <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. J <br /> 5. Av0r Col <br /> m m m g m <br /> m � 3ayu"121 <br /> 6. m o � 3 <br /> v CW1 <br /> @ <br /> 0 <br /> 7. =y : <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my L7 c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m <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- <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 ab scribed premises at any reasonable time for the purpose of inspection. - <br /> CDCD <br /> 02 / <br /> 000 <br /> SIGN <br /> SIGN HERE . ' <br /> (signature of r or building contr to) 1 (date) <br /> ZONING ADMINISTRATOR w w w cn to d+ <br /> 0000000 <br /> TOWNSHIP PERMITS MAY BE EQUIRED 0 0 0 0 0 0 0 <br />