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L17 ile'e-WLIC2 <br /> Durnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N <br /> OWNER TELEPHONE S97o <br /> m <br /> HOME ADD ESS <br /> �l Is'`= � N <br /> EMERGENCY/FIRE NUMBER ROAD NAME ' ~ <br /> LEGAL DESCRIPTION(see tax receipt) T Q rn <br /> m <br /> n <br /> 0 <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE 1:1 ADDITION ❑ PRIVY ❑ cn ° <br /> TYPE OF PERMIT(S): v ' <br /> FILLING/GRADING 0 CAMPING UNIT J❑ SUBDIVISION <br /> STRUCTURE/ADDITION USE: �/ \ V // ��/��/�� ((i —/// y <br /> 0 <br /> U-)0 <br /> nn n(Hoom-e/Cabin; Commercial Business; Bedroom, Deck etc.) ur <br /> BUILDING CONTRACTOR l l N/,,UU ��� v�sl/ Er <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n0 OZT <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. t7 o0i <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). y ° <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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 <br /> BUILDINGS,ROADS,LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. So <br /> O 9 �- <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN 4 S, <br /> NEEDED. 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z0 <br /> SAU� ` <br /> CONDITIONS OF PERMIT: <br /> c <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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. 1 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> m � m' m0. 9 <br /> 6. �.� 3 nm FI A <br /> Z N C W, m o'' <br /> 7. OZ :: y �K :W !R =OV <br /> — N; <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 0 Cr i IM <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of ; <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m 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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. 1y i <br /> m <br /> SIGN HERE <br /> (signature f owner or building cont ct r) (date) <br /> �zjZONING ADMINISTRATOR ' . 49 <br /> Ila to to to is to <br /> N9 NNN (n un <br /> Vr Vt O Vt ut O 0 O <br /> WNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />