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s <br /> lurne t County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -U G) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N 0 _ <br /> OWNER � L7K/jl/�, TELEPHONE 7/-S� <br /> HOME ADDRESS /Qhti je/�� <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) pa cn <br /> 0 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ y <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ElSUBDIVISION ❑ 5 <br /> STRUCTURE/ADDITION USE: Att S/� L. )C1 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) rn N <br /> BUILDING CONTRACTOR: G� / Er <br /> w A) �s3 <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 /> M <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <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). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO rn3 <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. A <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 ,1 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS �V <br /> MUST BE SIGNED AND DATED BY THE OWNER. So ) <br /> O 9 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Cr <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: <br /> h <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMISSUANCK`/A, tJ <br /> 2. REMOVAL CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG S LINE.'V��� / <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFI Y //�� A'L' <br /> 4. NO STPERMIRUCDTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN IRED W�A�fE '9 <br /> SETBACK <br /> �'V vng �f <br /> SETBACK REA. I (� J, t/A <br /> 5. LI/Y/, /rEe �£f+II!« LZGf i eit <br /> i. PI <br /> �h a/Urs M -a 0� 0 0 -0 <br /> 6. U, ca rrd or- Pi �Ajci <br /> aGe._ le. N'o 5o, / e f D a N a <br /> or <br /> q 20 <br /> fl)AX CVL Lt <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Zj c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize 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 p <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. m <br /> a� CD <br /> SIGN HERE <br /> (signature of ow or bu di o c (da e) <br /> ZONING ADMINISTRATOR ' �n <br /> to <br /> N NUINN (71 fJ <br /> fT UOCICn00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 0000000 <br />