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q1V 'V t1" <br /> @ rnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N <br /> C <br /> CL <br /> OWNER �/ k�t�t K4 ke— TELEPHONE o <br /> HOME ADDRESSO� is IAI d woa d GST Dam- iY c,, ,LTJ r <br /> r m <br /> 0 <br /> EMERGENCY/FIRE NUMBER dR d 6 ROAD NAME 1t), dwo0 d LitF <br /> LEGAL DESCRIPTION (see tax receip6q) C5- C' /"r v/I P/6/7 _ �� Q�}-4(U �� m <br /> _ fGT 0 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE Iql ADDITION ❑ PRIVY ❑ fn <br /> TYPE OF PERMIT(S): Q rr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: C[Y'QGgWiC.2 y' <br /> t � <br /> /Cabin; Commercial Buslne s; room; Deck;etc.) U) <br /> �j <br /> BUILDING CONTRACTOR: �M 6"j VW � (^ <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8' m F PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. S.r -n ^' <br /> M 0 1 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL O O a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C �p�) <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 <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 /> S. 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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a ° W <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o I <br /> CONDITIONS OF PERMIT: Ca <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. Q <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. v/` � vnr- O� Ov <br /> m M. m2) m m <br /> 6. (OD 0. NHa M <br /> v m C y 0 ° K <br /> Z m COD °f0 =j <br /> 7. 0 .O <br /> =N: <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my (1 c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of 'V n 0 C <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize O 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- 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 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 described premises at any reasonable time for the purpose of inspection. T <br /> nr <br /> m : <br /> SIGN HERE /Y16! <br /> (si re of owner or buildin o rector) ( te) l <br /> ZONING ADMINISTRATOR <br /> EnEnwwm <br /> N NM(nN No(n Ut <br /> V1 Vt o ut N O O <br /> OWNSHIP PERMITS MAY BE REQUIRED VOO 0 0 0 0 0 0 <br />