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QhZ'm�vi.� <br /> Burr, :3tritty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator q o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> o <br /> N <br /> C <br /> OWNER1•,� d Mai �VI1 \ 9'l g Ur ei TELEPHONE 'l/�—E�.��-'Z5,6- o <br /> QIP QN m <br /> r M <br /> HOMEADDRESSNDQgg47 /03! St /�IdEr 64111,1 S'¢o2� m <br /> �arr�-bee Sybd�V� <br /> EMERGENCY/FIRE NUMBER 2 4 7 f Z ROAD NAME Rca <br /> L v7' 9 <br /> o4' V o! LAfIF Sub �'vis,'eh �ur.7ez't 1 <br /> J <br /> Q { o� /.ofS44nd5 �+ 0 <br /> LEGAL DESCRIPTION (see tax receipt Q Z PL OV` <br /> 0 <br /> 5 DWELLING/BUILDING ® GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ N <br /> c <br /> TYPE OF PERMIT(S): T j <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDI�VI`SIO��/l C� s� , <br /> V Vr o <br /> NoyK� cA,6 <br /> STRUCTURE/ADDITION USE: Sal 4 rA <br /> (Home/Cabin; Commercial Business; Bea <br /> Deck;etc. i7 ttOp I p1 <br /> q omeu� <br /> BUILDING CONTRACTOR: R d � �� S <br /> i <br /> CD <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'h X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. � N o0 <br /> O m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n Z <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 o <br /> NORTH(N). <br /> OF THE FOLLOWING: (A)BUILDINGG <br /> S)TO ALL LOT LINES,(B)BUILDING(S)TO <br /> 3. SHOW DIMENSIONS IN FEET m a <br /> UREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF o <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEAS <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 TOGRADED FILLED. s <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILLDER,CONTRACTOR, <br /> CTOR, ETC.,THE PLANS I U52, o r <br /> MUST BE SIGNED AND DATED BY THE OWNER. v, <br /> BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN P <br /> g <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST <br /> NEEDED. - <br /> Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. P <br /> CONDITIQNR OF PERMIT: C>+ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR 3. NO GRADING OR SHIORELAND ALTERATNG OF TREES AND IONS AREIO ALLOWEDIS UNLESS SPECIFICALLY RLINE. <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. Ru� ' / �y <br /> ��. Y./ LA ,'I*% 0� V �J'a'If't o'�f ��-� f't � . or, r�� �g m <br /> N� U 3 nm xa _7e <br /> CCD) c <br /> ,br,les 'f 7i 6e �J y 0 o , 3 <br /> _Sp �Y r CD7. <br /> ccompanying schedule) has been examined me and to the best of my <br /> I declare that this application (Including any a <br /> m m 'late. I acknowledge that I am responsible foror the detail and accuracy of <br /> knowledge and belief it is true, correct and comp <br /> s application(including any `� a� <br /> r oGO, ? E i rn <br /> all information contained in thiaccompanying schedule)and I further declare that I recognize m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> sue apermit. 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. 1 agree to permit county officials charged with administering county ordinances or other . <br /> authorized perso .to he c ss tot bove described premises at any reasonable time for the purpose of inspection. CD <br /> SIGN HERE (d e) _ 'Y <br /> (sl at a of owner Ing contractor) <br /> to to to w<n to <br /> ZONING ADMINISTRATOR N N V N N V N <br /> v, 5nocn �noo <br /> 0 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />