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RulOabft County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -V G 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> - r <br /> F O <br /> w <br /> c <br /> I' <br /> OWNER G�g�TAU�Ca�12)�`7 TELEPHONE 3_ ya 9 b o <br /> HOME ADDRESS /OS--9 � 90T h Je FRepudR,)G <br /> r m <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME pRr9T T <br /> /.✓ Go V 4T.2 <br /> LEGAL DESCRIPTION (see tax receipt) zo r' 7 �M V (Ir P 'wcn <br /> 0 <br /> DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ CO 0 <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5 <br /> STRUCTURE/ADDITION USE: Ca 61 ti A"o"D poo.45,14 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) m <br /> m <br /> BUILDING CONTRACTOR: CD <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/x X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> O <br /> � N C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> if, <br /> TZ <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 IF <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m o <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. 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. ' Q <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. \ IV <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS n <br /> MUST BE SIGNED AND DATED BY THE OWNER. I o )CJ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN —) q S <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. a �I <br /> CONDITIONS OF PERMIT: ^� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Q <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <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 1�z <br /> SETBACK AREA. <br /> 5. <br /> Xvm ? vov <br /> m <br /> 6. < 3 o. y Q -- � <br /> n c,n 0 5 3 <br /> m O �� <br /> 7. o : <br /> —_En- m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my i i C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o it <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m 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. 1 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. -n <br /> CD <br /> m : <br /> SIGN HERE • - ,97 <br /> gnature ofo ner or building tractor) (date) <br /> �a�• <br /> ZONING ADMINISTRATOR . . . . . . <br /> wwtn to cn tn� <br /> N <br /> IT NNP! fU1 <br /> (T O PV1 U1 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 <br /> 0000000 <br />