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ftimett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 e"� 'Y <br /> Office of Zoning Administrator Q Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> 57 o <br /> OWNERPu 1 �UU Io !C KIV,01) CD <br /> Zi t <br /> TELEPHONE <br /> HOME ADDRESS lc DR. VAQup i's §61s AP ,�10�7 � �� <br /> � <br /> EMERGENCY/FIRE NUMBER / 3 ROAD NAME /y(t/,/ ZAP o <br /> 70 <br /> LEGAL DESCRIPTION (see tax receipt) �E jj^T /7- ?7- /? <br /> 7 ?7 „/f�' <br /> / I tJ N <br /> CD <br /> DWELLING/BUILDING T GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ o' <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISIO ❑ a <br /> STRUCTURE/ADDITION USE: d o. <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) -pT_ <br /> BUILDING CONTRACTOR: <br /> /CCN 9CA1h j!i <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR CD <br /> 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) IX!O <br /> T a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T ? <br /> n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> rn <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 3 <br /> CENTERLINEG <br /> OF ROAD,(C)BUILDINGS)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 <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N O1 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 1 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. a <br /> 0. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN O <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <br /> 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> SHORELINE. <br /> 2. REMOVALOVALOR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY_ <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITH TIJ5Rf>`QJtIIP4EO�VA7ER <br /> SETBACK AREA. j <br /> 5. <br /> _ I <br /> 6. 0 ��eyltCiV Q(YI �CCt�530v aI] � — ra01 �i ' � " MW 0CDafm <br /> 9 y U"U 2 3 a ,D Oam m <br /> 7. CIDo y 0 <br /> TV <br /> T <br /> I declare that this application (including an accompanyingschedule has been exa and to the best of my IJ <br /> PP ( 9 Y ) <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofm c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ` 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 <br /> authorized pensto have access to the above described premises at any reasonable time for the purpose of inspection. iD <br /> -n <br /> CD a <br /> SIGN HERE <br /> (signature of owne orb Iding contr r) ate) <br /> ZONING ADMINISTRATOR 0 <br /> TOWNSHIP PERMITS AY BE REQUIRED <br />