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No. 102,Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> PLICATION FOR LAND USE PERMITS . <br /> 0 <br /> N <br /> �� TELEPHONE s 3 7 S��_ CL <br /> \ CI�� <br /> J\ w <br /> m <br /> MAILI,iGADDRESS (j 77 'Z. S !o{e/T cVvc- is C j /� l t4lftO/3VicX �,O/V SS /LSA 3E <br /> r m <br /> 0 <br /> PROPERTY ADDRESS C- L/Y ✓� / <br /> LEGAL DESCRIPTION(see tax receipt) S / 36-4o- <br /> DWELLING/BUILDING ❑ GARAGEIACCESSORY STRUCTURE ADDITION ❑ <br /> TYPE OF PERMIT(S): <br /> �&� <br /> /FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ ly S. <br /> / NSTRUCTURE/ADDITIONQSE: �A j/G — 13�_ °y - � 3 4 ter!~t`�+ A /2 d 5 <br /> (Home/Cabin;Commercial Busi ass;Bedroom; Deck;etc.) rn <br /> BUILDING CONTRACTOR: 6y/l'e/CZ" Muvte �ave�� / [►. /2( �c'�✓rE f <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. O Cr <br /> N G <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m T� <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE V <br /> NORTH(N). 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)70 rn <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. P <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO I <br /> BUILDINGS,ROADS, LAKE,LOT LINES. — <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS 0, <br /> MUST BE SIGNED AND DATED BY THE OWNER. G o <br /> r � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY qkDONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. /I \ o Q <br /> CONDITIONS OF PERMIT: Q� <br /> vl <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ©Cj <br /> ISSUANCE.2. REMOVAL OR SCJ <br /> 3. NO GRADING OR SHIORELAND NG ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY OF TREES AND VEGETATION IS RESTRICTED ALONGSHORELINE.�� ?-V� O <br /> PERMITTED. O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WAIU� <br /> SETBACK AREA. <br /> 5. This structure to be used as private residential M n r D v D o a <br /> CD w002nFm <br /> 6 garage/storage only. Not to be used for human a w x <br /> habitation. z y C o <br /> 7. P 'I'< ; m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m r^ <br /> PP ( 9 Y ) Y Y <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a N <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- <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 w <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other o <br /> : v�: <br /> authorized person to have ces/sto,the above w <br /> described premises at any reasonable time for the purpose of Inspection. - o <br /> CD <br /> Cs'L"'�- w m E <br /> SIGN HERE U -O J� d' ' C <br /> signature of owner or building contractor) (date) n <br /> ZONING ADMINISTRATOR 07M 1 '411 (l <br /> TOWNSHIP PERMITS MAY BE REQUIRED Toy a57o L)t(:k, UloCA C� oo <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE lqb 6 K A-P <br /> 2.1P5`?1 4F <br />