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j0 Co. Rd. K, No.102,Siren,WI 54872 Office of Zoning Administrator M o° 0 <br /> APPLICATION FOR LAND USE PERMITS CD <br /> N »� <br /> N o� <br /> TELEPHONE �p `(o �S�/-j lo 7 S 0 G <br /> MAILING ADDRESS l J J g TH J 'Vz: p�n�7 ""`m�V�"�r' O� � m <br /> C ,Qc/ / /may , O <br /> PROPERTY ADDRESS //eC�t ( c r <br /> C T/o�j �(l SQ/� �n�iJ <br /> rn <br /> LEGAL DESCRIPTION(see tax receipt) <br /> � o <br /> DWELLING/BUILDING ® GARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ a' <br /> TYPE OF PERMIT(S): 2: <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ S. <br /> 3 8 a - �� a <br /> STRUCTURE/ADDITIONOSE: (n T <br /> (Home/Cabin;Commercial Business; Bedroom; De ; etc.) <br /> BUILDING CONTRACTOR: Tf M iqukcs- <br /> 'o <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/s X 11 SHEET OF PAPER. ANY INCOMPLETE O TO 3 ( , <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING_ (AERIAL OR TOP VIEW) n n <br /> -n O Z <br /> 8 >n 3 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NEI)AND INDICATE C O <br /> NORTH(N). m a <br /> m <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUIL ING(S)TO <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(OF),AND ALL DISTANCES TO <br /> BUILDINGS,ROADS, LAKE,LOT LINES. N <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED.TC.,THE PLANS S. -- <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, o <br /> MUST BE SIGNED AND DATED BY THE OWNER. p C <br /> �pj E WHEN ° <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VEI� WH _ <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. j i i I <br /> �� P <br /> CONDITIQNR OF PERMIT: y 01 � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS Ok1J n�11/ Q <br /> ISSUANCE. /v C>b kJ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHOREI A A,I V uN]�i <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY `'�� N <br /> PERMITTED. ^ <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WAT R <br /> SETBACK AREA. / _ Q / `Cj I S S Li-e- <br /> 5. <br /> P� <br /> 5. /llJ\1�` �—jJ " 5 `( �o n m o m a o M <br /> 03 c&acm Fam � <br /> 6. <br /> Z N o : <br /> o a,� m <br /> 7. =cam : i p <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 1 am responsible for the detail and accuracy of m Fn i y <br /> all information contained in this application(including any accompanying schedule)and I further that I recognize <br /> declire mm m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether tom ? m <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 ? (n, <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. ; m , <br /> m <br /> / 6 E <br /> SIGN HERE <br /> (si nature of own r ding contractor) (date) <br /> ZONING ADMINISTRATOR l ��- <br /> u N <br /> o 1 N N N <br /> TOWNSHIP PERMITS MAY BE REQUIRED a"/� Ln <br /> oO Oo <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE va--w)L � <br />