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Bur County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITSI COMpUTER/SC NN90 Q <br /> on <br /> b� <br /> OWNER To bgtf <11 L)----L)---- TELEPHONEUzi <br /> HOME ADDRESS � oq Wds-krl <br /> t V"`t 0 <br /> EMERGENCY/FIRE NUMBER APAD NAME <br /> 'qa -16 4- <br /> LEGAL DESCRIPTION(see tax receipt) GUt �/ �1 �' <br /> ) <br /> ❑6AWS y 0 <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY o <br /> TYPE OF PERMIT(S): <br /> FILLIN /GRADING ❑ CAMPING UNIT ❑ SUBDIVISIO ❑ <br /> Q �t �� �/ / N <br /> STRUCTURE/ADDITIONU :r) 1lYY/1� GXlS1��tetiorh�) a&,Y, �Q Chcd y 1Z111 <br /> /(Ho //CCaabin; /iommera Bus ess; Bedroom; eck;etc.) 18 (� ur <br /> BUILDING CONTRACTOR: e `�^^' / ®r T %bX <br /> Qa <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE R 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> ;b c <br /> PIpGQi�Me FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> m Z <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 n <br /> NORTH(N). N 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING:�BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m a <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF o <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. VJ N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS I 0. <br /> MUST BE SIGNED AND DATED BY THE OWNER. to o <br /> 4 � a <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q <br /> NEEDED. 2 C <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: `` /1 (V_ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT RC1 p) <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. \ Q q <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ( (y <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. 1 <br /> 5. S tlYcc�+reJ {v ()2�L/¢T �?�St 3a r'f r�rOn p(G�eri�f /.� a G�Lc v <br /> 6. A)o j` w t l N(N S U� E' �hClt l wli, �j5�v 41�'��/k Uu m. y K N <br /> 1 11 ME <br /> (J tp� C m <br /> �6 Zup <br /> : m WM <br /> iNgfffift!� o2m <br /> I declare that this application (including anj accompanying sched e) has been examined by me and to the best of my 3 c C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of ii <br /> all Information contained in this application(including any accompanying schedule)and I further 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- O <br /> sue a permit. I further accept all liabiI' which may be a result of the County of Burnett relying on this information 1 am <br /> providing i is n. 1 a ee t permit county ,cials charged with administering county ordinances or other m <br /> authorized erso have ac ss o the above Oesylibfd premises at any reasonable time for the purpose of inspection. m <br /> CD <br /> Co <br /> SIGN HERE � I <br /> gnatu a of owner or b in tractor) _ (date) <br /> ZONING ADMINISTRATOR <br /> 40 4001 40 <br /> cNi, cNi,o , cn I <br /> TOWNSHIP PERMITS MAY BE REQUIRED 000 , <br />