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10 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator o 0 <br /> APPLICATION FOR LAND USE PERMITS 3• s <br /> N W <br /> / / CL W <br /> % TELEPHONE <br /> L9 0 <br /> r <br /> HOME ADDRESS O `~ <br /> ROAD NAME 7 � <br /> EMERGENCY/FIRE NUMBER C r <br /> a') m <br /> LEGAL DESCRIPTION(see tax receipt) ? _ _ �/ o o ti� c <br /> N <br /> c <br /> DWELLINGIBUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY a <br /> TYPE OF PERMIT(S): 5' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ �� P m <br /> STRUCTURE/ADDITION USE: y <br /> (Home/Cabin, Commercial Business, Bedroom Deck etc) <br /> E3 <br /> BUILDING CONTRACTOR: v <br /> -11 3. <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8Y,X 11 SHEET OF PAPER. ANY INCOMPLETE OR 0 m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T <br /> M m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m v <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)T <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF ( c <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 TOIL GRADED RA FILLED. ? o I <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS t7 § <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN g '^ <br /> NEEDED. Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CON DInnNS OF PERMIT. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. SIJ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> ING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> 4. NO STRUCTURES,INCLUD <br /> SETBACK AREA. v m 7 0 m <br /> 5. 30 ° N o 3 <br /> CU) �0 <br /> e � a i q <br /> 6. o : .0 <br /> _rni i : m <br /> 7. <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best nsible for the detail anac o � c <br /> knowledge and belief it is true,correct and complete. I acknowledge that scheduleoand I further declare that I recognize ' m ; '•; m <br /> all information contained in this application(including any accompanying ) gj <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> I am <br /> sue a permit. I furtherapplication. Ilagreelity to perlch may be a result mit ounty officials also charged with administering lcounty ng on toirdinan esdornother <br /> m : <br /> providing in this app - . <br /> authorized person to ave access to the above described premises at any reasonable time for the purpose of Inspection. , <br /> u,i ( e) <br /> SIGN HERE E <br /> slgna f owne r build g contractor) <br /> e tANNfn W(A� <br /> N NfJ, NN �N <br /> ZONING ADMINISTRATOR rn v o 0 pt o 0 <br /> 0000000 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />