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ex c'J- <br /> Burnie t Caranty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v c� Z <br /> APPLICATION FOR LAND USE PERMITS 3 4 <br /> r <br /> 0 ~ <br /> C <br /> OWNER i TELEPHON c <br /> 'jt � Ani C7s) 6 -a0a 7 a W <br /> 7 L•._..` tCK..,a C i �.sc.5 S�c i <br /> HOME ADDRESS,,,2 go <br /> rt�� iy Y Lo l <br /> EMERGENCY/FIRE NUMBER L; t1zw C•� ROAD NAME ^aroma( 2 ar� <br /> LEGAL DESCRIPTION(see tax receipt) 07 <br /> a!"erra�.ort L i�CL hf kc-.•a [l/tJ (re r ut.� <br /> O <br /> TYPE OF PERMIT(S) DWELLING UILDINGGARAGE/ACCESSORY STRUCTURE ADDITION <br /> a" <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> N <br /> m <br /> STRUCTURE/ADDITION USE: <br /> Hom Cabin; Commercial Business; Bedroom; Deck;etc.) -0 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> 0 w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T <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 C Ci <br /> NORTH(N). N 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m r 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, <br /> STREAM OR RIVER. I c <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- <br /> INGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. rr�� <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 't/ 0• i <br /> MUST BE SIGNED AND DATED BY THE OWNER. m o <br /> o �J <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BEa ° <br /> ISSUED. <br /> I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: p <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT N, <br /> W <br /> ISSUANCE. ^4_� ?tzs <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. C> <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY p 0 1 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED I THE OHWM OF LAKES, <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. II jjvv== y- <br /> 5. <br /> -Qi ;0 -00C)r C?Cr-rl <br /> d m <br /> 6. MqY � <br /> CN r/ <br /> N ;1y � a _ <br /> '7 Z N 'as <br /> 7. eU P <br /> =0' m <br /> I declare that this application (including any accompanying schedule) has been n a and o the best of my t S c i p <br /> knowledge and belief It is true, correct and complete. I acknowledge that I am 1 it and accuracy of o C <br /> all information contained in this application(including any accompanying schedule)an rther 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- m v <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this Information I amm <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ; m E E <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. T <br /> m <br /> SIGN HERE ---S��ZS �U 1r�71. a tnl a 426 A? g � <br /> 42 '• <br /> (s <br /> ignat <br /> ure of owner or building contractor) T (date) <br /> ZONING ADMINISTRATOR . . . . . <br /> N ut ON f/i00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0N 0N0IJi C"> <br /> NN00 <br /> 0N o 0 o 0 0 0 0 <br /> 0 <br />