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P Yn4ft County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N O <br /> OWNER ��REnJ`� �CFtAI.(l3ScNLslC�EOZ TELEPHONEC;)ISj <br /> .. V1 <br /> �/,��p O <br /> HOME ADDRESS ,¢Ve I�reSSe P, 'JZ T90' 0 t _ <br /> r <br /> 0 <br /> EMERGENCY/FIRE NUMBER L/ {/ ROAD NAME V �� <br /> co <br /> LEGAL DESCRIPTION (see tax receipt) L z3 d <br /> �C77f( <br /> 1 2 <br /> DWELLING/BUILDING Y GARAGE/ACCESSORY STRUCTURE MADDITION ❑ PRIVY ❑ O ° <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ O' <br /> STRUCTURE/ADDITION USE: hr0✓1//�= C�!i/�� N, <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) N <br /> m <br /> BUILDING CONTRACTOR: m <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR B. <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> ME) ' Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDINGS)TO ALL LOT LINES,(B)BUILDING(S)TO m t1\ rte_ ( . <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF ( I o�) <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ki <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. ) <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS C '� <br /> MUST BE SIGNED AND DATED BY THE OWNER. o' f <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATIA0 MA)f F DONE WHEN O <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. v j/ i ; o <br /> CONDITIONS OF PERMIT: nT ,/p1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF I �'/2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHO � �D�� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY «pN�ppc� oej <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATE)2 rl� <br /> SETBACK AREA. h✓1, <br /> 5. <br /> Xm nrDV Dv � <br /> 6. m 3 n m x n � <br /> N C: y N O <br /> y N <br /> 7. 0 : T� Z1 <br /> = m <br /> v <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c 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 <br /> : m D <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- O <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 ° <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <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 /> , ll-- <br /> SIGN HEREyLC�Llry��� 7 L0-- 02- " 0 <br /> (signature of owner or building c actor) (date) <br /> ZONING ADMINISTRATOR <br /> I � <br /> TOWNSHIP PERMITS MAY BE REQUIRED ` <br />