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,ty 7410 Co. Rd. K, No. 102, Siren,WI 54872 <br /> Office of Zoning Administrator (P o 0 <br /> APPLICATION FOR LAND USE PERMITS o <br /> CL <br /> 33 <br /> � T TELEPHONE 7�5 SCG - 73 0 <br /> OWNER e51/) <br /> HOME ADDRESS �� 30 ( trGe��. h �cl �e'b54 �I^ W ` ������ <br /> ROAD NAME <br /> EMERGENCY/FIRE NUMBER '^d Gp�G n % ^ ^ R d <br /> LnSU <br /> / Cn <br /> � Cn <br /> / , h eS �oYs eZG z7 zP z d�3o <br /> LEGAL DESCRIPTION(see tax receipt) T4/D /Z /7W //l,C <br /> DWELLING/BUILDING [:1GARAGE/ACCESSORY STRUCTURE ISI ADDITION ❑ PRIVY LJCL <br /> TYPE OF PERMIT(S): K <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION <br /> 5. <br /> /,2 1i l7ecK SG Va � 7. house � ry <br /> STRUCTURE/ADDITION USE: (Home/Cabin; Commeraal Business, Bedroom, Deck,etc) y <br /> BUILDING CONTRACTOR: 17 e v <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81AX 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. y <br /> O m •� <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) in v Z <br /> m m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. N _ c <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE 3 <br /> NORTH(N). m <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO <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 t `, <br /> BUILDINGS,ROADS,LAKE,LOT LINES. c �N <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 0 c 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN g ° <br /> q <br /> NEEDED. Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. P <br /> CONDITIONS OF PE-RMII <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> CUTTING2. REMOVAL OR <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS S EC F CALLRY LINE. <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. m. ao <br /> � vCimuo '3 <br /> %ii O . <br /> 6. Z y CD Cl o : <br /> � : <br /> m <br /> 7. E c O <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true, correct and comp <br /> ancuracy of <br /> late. I y accompanying schedule)and I further declare a e that Ir the detail and knowledge that I am responsible foc recognize 4 fD � O <br /> all information contained in this app (including y <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of <br /> inspection. m <br /> /C�%� -3 Ae/ D <br /> SIGN HERE <br /> (date) <br /> g to f o er r building contractor) <br /> wwwvrtflcn� <br /> ZONING ADMINISTRATOR N N 0 N N v, <br /> u, CA0Ln noo <br /> 0000000 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />