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Burnvc,''-CoZntX 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 G) z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> OWNER -D&:1y1y)S 1.:' '_7� TELEPHONE�f�-a'3J_ d697 0 <br /> HOME ADDRESS <br /> Z_-!q l / vis .mak �/�,e� l�J T -547)/ <br /> r m <br /> 0 <br /> EMERGENCY/FIRE NUMBER '70 ROAD NAME � � <br /> LEGAL DESCRIPTION (see tax receipt) y <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITIONIR PRIVY ❑ y0 <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5 <br /> STRUCTURE/ADDITION USE:��(///i(/e�i' /i" '� o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) y <br /> BUILDING CONTRACTOR: lir <br /> 1 <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE O 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> See Ua,,,'iaN_C U( 0 F 3 <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) 7 U acr 0 1D tr <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SC/ALE. 5� m z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 1� <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <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 /> S. 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. c <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a o, <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT O <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY \ G <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> A -00mr- M <br /> 6. � 4 m � a g m <br /> �� mcueoi �o - 3 <br /> P <br /> =y : im <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracyof O' m e c <br /> PP (including Yaccompanying ) recognize <br /> all information contained in this application Includin an schedule and I further declare that I � � (D : m <br /> that this inform:fu' <br /> t1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- obi : p <br /> sue a permit. I h r accept all liability which may be a result of the County of Burnett relying on this information I amproviding in thip lication. I agree to permit county officials charged with administering county ordinances or other to <br /> authorized pers have access to the above oqscribjpd premises at any reasonable time for the purpose of inspection. T <br /> SIGN HERE <br /> ( na re of o pr r building contractor) (date) <br /> J/ oG <br /> ZONING ADMINISTRATOR 40 <br /> t»m to fn to is <br /> N N01 NN 01()1 <br /> Ut 01 0(T Ut 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />