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Burnett Count 7410 Co. Rd.K No. 102 Siren WI 54 72 <br /> Y 8 Office of Zoning Administrator v 0 z <br /> APPLICATION FOR LAND USE PERMITS . <br /> r <br /> a o <br /> \���J //9 �/ t <br /> OWNER 1/D�/'P_ rl •� �l/�2 TELEPHONE 7is m <br /> - /8�_�79, <br /> MAILINGADDRESS <br /> PROPERTY ADDRESS S� r <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ Cn 0 <br /> TYPE OF PERMIT(S): `C (� <br /> FILLING/GGRADDING ❑ CAMPING UNIT ❑ SUQDIEvol <br /> N ❑ <br /> STRUCTURE/ADDITION USE: a Oc)3 LF`E K�o ��A�"JJIIf p(yt¢� �� o <br /> (Home/Cabin; Commercial Bu&ness;Bedroom; Deck;etc.) <br /> v <br /> BUILDING CONTRACTOR: <br /> 'D <br /> CD (� <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/,X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. _n 3 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p <br /> -n n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m :° <br /> NORTH(N). <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO CO) O` 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 1 `Z <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. QQ o <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. C d <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N (N`" <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER TRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. .3 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE RIFIC N o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. '14r 6 Z <br /> CONDITIONS OF PERMIT: e o p <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PE ` <br /> ISSUANCE. URR <br /> ,OUJ2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHOREELINEEG <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY vj � <br /> PERMITTED. 1 <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> 5 <br /> SETBACK <br /> C0 W 0 M D 0. v M <br /> 6. 2 3 a0 Fam <br /> N C <br /> 7. Z v 0 1 <br /> O n� - r� <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G N A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy ofiu to : C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m : o : m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am I �, d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other v <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m : c <br /> o : <br /> CD <br /> m <br /> : m : <br /> SIGN HER Z S <br /> : a : <br /> (signature of ner Ar building contrac (date) <br /> I , <br /> ZONING ADMINISTRATOR 1� <br /> fA fA fA 6A� N <br /> N (T N N O O <br /> TOWN IP PERMITS MAY BE REQUIRED 0 0 0 cn o 0 <br />