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Surn6tt,tounty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator � o <br /> APPLICATION FOR LAND USE PERMITS 3. 4 <br /> y o <br /> OWNER CL <br /> TELEPHONE TELEPHONE (fi5j, jjQb�aQ <br /> o <br /> HOME ADDRESS <br /> 1.pPGcd �ar 4re_ nvun.Lcr <br /> o ; <br /> EMERGENCY/FIRE NUMBER g qq ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt)pixina%Ari5 <br /> m <br /> TYPE OF PERMIT(S): <br /> DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ❑ ADDITION 1:1PRIVY El0_ y � <br /> _ <br /> rr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5 <br /> STRUCTURE/ADDITION USE: e, o' <br /> (Home/Cabin; Commercial Busine ; B d om; De k;et Cn <br /> BUILDING CONTRACTOR: -t -t <br /> E <br /> v 1 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. / -n 3 <br /> EW) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VInV <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE.. m Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE i <br /> NORTH(N). <br /> 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 SZ <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 1 J c <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. C O <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR,ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. �D c O <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHENa 0 <br /> NEEDED. 0 <br /> 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z (� <br /> CONDITIONS OF PERMIT: c <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 <br /> ISSUANCE. Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY .a <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. ly <br /> 5. lY <br /> • m c H , 0 5 3 <br /> o <br /> =CA p <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of rrn. d C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize Ci CD <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to is- 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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to access to the above described premises at any reasonable time for the purpose of Inspection. T <br /> SIGN HERE t q to I I q <br /> (signs re of owner or builds o tractor) (date) <br /> ZONING ADMINISTRATOR <br /> fn tnwwww-� <br /> N Ln K) 0 <br /> M (n O (n UI OO <br /> TOWNSHIP PERMITS MA BE REQUIRED 0 0 0 0 0 0 0 <br />