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Burne%County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrat� - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N O <br /> YI <br /> C '^ <br /> / V I <br /> OWNER ���� ��-�� TELEPHONEb�Z,��./J�-� 39�9 <br /> HOME ADDRESSD7 <br /> [ 0 <br /> EMERGENCY/FIRE NUMBER ROAD INIME�(e441644JZ>ZAAChE <br /> 7�N�iP�co�T <br /> LEGAL DESCRIPTION(see tax receipt) � W <br /> ` 0 V - <br /> �� e <br /> DWELLING/BUILDING 50 GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ rn <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRt/ADD/ING,��❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5 <br /> STRUCTURE/ADDITION USE: /T>DIT467 AWL> Cf7�/' ��—� T.0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) cn <br /> , aee �O <br /> BUILDING CONTRACTOR: <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR ,n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 M SJ <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 <br /> NORTH(N). N oA <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO IM 3 <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 Q� <br /> MUST BE SIGNED AND DATED BY THE OWNER. m C> <br /> 0 <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. 0 1"") <br /> CONDITIONS OF PERMIT: �G <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. ](� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. i <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY r� I <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. .� <br /> p v n r O C M <br /> m m m m <br /> 6. mam 0 9' 3 <br /> • m C m . <br /> o <br /> 7. o <br /> _ cnA <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of myLj c ID <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of �� o C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize �'t m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- l7 <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 m <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 describedremises at any reasonable time for the purpose of inspection. m <br /> m : <br /> m : <br /> SIGN HERE �tl� <br /> (signature o 0 o din con to (date) <br /> ZONING ADMINISTRATOR ' <br /> U�riUlN�01, <br /> NN N ul0 <br /> (!1 (l1 O V1 Ut O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br /> 40000000 <br />