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601CI( <br /> Buinett'.:ounty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ' o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> - r <br /> 41 � <br /> (715)635 - 3133 a <br /> OWNER j1„ AIJ �£SZ�� 1lMAn� TELEPHONE`�7� � � o <br /> HOME ADDRESS F <br /> t 'm <br /> EMERGENCY/FIRE NUMBER � �.� ' ROAD NAMEC^9L�rT� ( o <br /> r�`' 7� <br /> N <br /> LEGAL DESCRIPTION (see tax receipt) ( ��I Y �> f L� <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION PRIVY ❑ rn ° <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CrIAMPING UNIT ❑ SUBDIVISION ❑ �' o, " <br /> STRUCTURE/ADDITION USE: 11f9vY�2 Ce'E9 c..r.7 <br /> (Home/Cabin; Co ercial Busin s; Bedroom; Deck; etc.) m <br /> <— G <br /> BUILDING CONTRACTOR:_' <br /> m <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 6Yz X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 - <br /> A N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 m <br /> n a <br /> � Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m v <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m \33 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <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. N <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. F <br /> o � 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o 17 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OFeER <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHl <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFIC <br /> PERMITTED. Q <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THEERSETBACK AREA. <br /> -)0-0) -�Uun aab-'l � 7�� 4 c84 G 8� <br /> o d g > ° n f m <br /> � I _ � 3 CL CD D. 3 <br /> 6. �, mC ^ m09 <br /> 7. CCN/ti��rV Z - " ° m <br /> O T� ' m <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of CL M <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize ` <br /> PP ( 9 Y ) 9 ID m p <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> G) : <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 otherCD <br /> / <br /> authorized person to have access tot above described premises at any reasonable time for the pu pos of inspection. T <br /> CD <br /> y� <br /> m <br /> Q <br /> SIGN HERE —�POL.�. v r( <br /> (signature of owner or building contractor) (date) �CC <br /> ZONING ADMINISTRATOR �� /C c�, n <br /> x�_ <br /> b� 8 <br /> ' <br /> TOWNSHIP PERMITS MAYBE REQUIRED ^p !n �(-345 <br />