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jn6z-y'1 <br /> BurrnPtt County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> 3CD <br /> �7-sso9 W <br /> OWNER TELEPHONE 7/5,3 o <br /> HOME ADDRESS 3 g �j h / tU Q + ' u ' /L +- V837 <br /> 1'YU rrie.vVc� ��j- <br /> EMERGENCY/FIRE NUMBER , ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) I (J�r— I ;31p— <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE 1q <br /> KJ ADDITION ❑ PRIVY ❑ <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ I S. <br /> m <br /> STRUCTURE/ADDITION USE: ,&,,,,"'^h""J— <br /> 47 (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) J <br /> 2. <br /> BUILDING CONTRACTOR: <br /> v <br /> M <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/a X 11 SHEET OF PAPER. ANY INCOMPLETE OR .n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 m <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) M ii <br /> ?� 0 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m n <br /> NORTH(N). ° <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <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 1 <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 8 <br /> MUST BE SIGNED AND DATED BY THE OWNER. S0 ° <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q ° <br /> NEEDED. This structure to be used as private a Ul <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS residential garage/storage only. Not to be o (U <br /> CONDITIONS OF PERMIT: <br /> used for human habitation. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT JCJ <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. )13 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. ' <br /> 5. (Lr� �31 T! 071 e e-I�lI[/L2 () "'� ��� z v c� � o o v <br /> 9 � IL�� lbt �IYI�, r �" M. 3 C M k m <br /> 6. �/i (D C'1 0' <br /> Z : W <br /> 7. <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize I" ° m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 4 O <br /> sue a permit. 1 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 m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> M :: <br /> CD <br /> SIGN HERE <br /> signa owner orbulldin ractor) ` (date) <br /> ZONING ADMINISTRATOR ^ifn v+tw cn w w <br /> N N 01 N N 01 01 <br /> ///� 01 01001 000 <br /> CD <br /> TOWNSHIP PERMITS MAY BE REQUIRED //Y� � 0 0 0�0 0 <br />