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It County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator o <br /> y APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N0 <br /> C <br /> N <br /> OWNER er��} Z6P TELEPHONE <br /> HOME ADDRESS C� IQ' („ QST (jelli� ly -( \ !A lYJ(-U'lU <br /> �C�r�vr�te fid) 1 0 <br /> EMERGENCY/FIRE NUMBERROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt)���� r—� cgs + 'A5 TT'Ni n oLk i't m \ <br /> 0 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION 5? PRIVY ❑ r- 3 <br /> TYPE OF PERMIT(S): 1- Z>ekX <br /> Cr <br /> a <br /> FILLING/GRADING ❑ C PING UNIT ❑ SUBp1W ❑ 5. <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) (n <br /> BUILDING CONTRACTOR: �i t <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/,X 11 SHEET OF PAPER. ANY INCOMPLETE OR n a <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 vy <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n n <br /> -n 2 <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 <br /> C <br /> �0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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 <br /> BUILDINGS,ROADS,LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. o O <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS 0002. ) <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Cr ° M <br /> NEEDED. <br /> z � <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: ( , ) <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. V <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n ,1 <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. zv0 ?� a <br /> 6 3 nm p 3 <br /> 6. Nmii Ifo <br /> Z : <br /> 7. m <br /> Cr <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my L7 A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of CL <br /> i <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize G <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 m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. - <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR �(f1q r ld (0i'1 <br /> viwwv+wtn <br /> En K) oo <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 0000000 <br />