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W-net:=county 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N O <br /> N <br /> C <br /> ,mow CL <br /> N <br /> OWNER 1��S�ti TELEPHONE (og --783-©4_'S7 O <br /> HOME ADDRESS <br /> CD <br /> CD <br /> p- �. o <br /> EMERGENCY/FIRE NUMBER zs % 2 ROAD NAME Ems- i S <br /> -/ <br /> LEGAL DESCRIPTION(see tax receipt) �16L !(p P S lcs�Tfc� m <br /> y a <br /> 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—)(--GARAGE/ACCESSORY STRUCTURE XADDITION oG `o <br /> CL <br /> S. ".t <br /> T. <br /> SANITARY IVY—,nFILLING/GRADING CAMPING UNIT SUBDIVISION O <br /> Cnmu;na <br /> STRUCTURE/ADDITION USE: ��/� / <br /> (Home/Cabin; Commerc' usiness; Bedroom; Deck;etc.) <br /> M <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). y 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO rs v <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, I Z <br /> 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 BUILD- <br /> INGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Iv <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. 'o e <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE SU <br /> 4 <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <br /> 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT p, <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORJLINE <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLPERMITTED.4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN 75 FEET WM <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED, ��/5. <br /> �2�V v1 t a, V 5O, SES J� �Jaly9 3 a Q <br /> el <br /> 6 seg e y <br /> N O <br /> Li N_ y. <br /> sm <br /> I declare that this application (including any accompanying schedule) has been examined by me an y�Pqf c C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail a accufaley o m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m IM <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ; ro <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. n <br /> r� m <br /> SIGN HERE . <br /> sig ature of owne or ilbu�ilddling contractor) (date) <br /> ZONING ADMINISTRATOR 11 � lC1n/��Illr 1 <br /> � 4 <br /> NK) <br /> N N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED o o o o ii <br />