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C'L <br /> BOrnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> 0 <br /> N O <br /> C <br /> OWNER IL G � �� n <br /> TELEPHONE <br /> o <br /> CD <br /> HOME ADDRESS �D � 1 � Ov <br /> le P r`/ry �V� N <br /> � <br /> r m <br /> EMERGENCY/FIRE NUMBER ? ROAD NAME O S"!344 <br /> p <br /> LEGAL DESCRIPTION(see tax receipt) 0) <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ <br /> y o <br /> TYPE OF PERMIT(S): ccr <br /> c� <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ _v 5 <br /> STRUCTURE/ADDITION USE: _ G�+�roe S'1bftAC� 0 � <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) y <br /> BUILDING CONTRACTOR: ki A � 1 <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN SY:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> 0 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. = <br /> O C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o. "CJ <br /> I (-)1` Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m A <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)BUILDINGS)TO ALL LOT LINES,(B)BUILDINGS)TO m B <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. W o <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. (y <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. yJ N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR,ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. OQ <br /> a � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN cr o <br /> NEEDED. 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT \ D <br /> ISSUANCE. lV <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. W <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER 1 d <br /> SETBACK AREA. `fJ <br /> 5. <br /> - 0 r 0 0 -0 <br /> 6. IDS 3 cm `ra x <br /> N C 0 i <br /> 7. Z : yCQ � -i <br /> p i X <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Zj c p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of S <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m m <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 1 am m <br /> providing in this application. I agree to permit county officials charged with administering county. ordinances or other (� m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. m <br /> : <br /> © m : <br /> SIGN HERE p /C(�j_. <br /> (signature of owner or building contractor) (date) <br /> gn <br /> ZONING ADMINISTRATOR gill I_ lo—wligjr n <br /> M110 �. LnCA <br /> N NCA <br /> Vf V1 ut O P <br /> 00 <br /> O <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 <br />