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Bur_—a",n�unty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v G) Z <br /> APPLICATION FOR LAND USE PERMITS 3 P. <br /> r <br /> y O <br /> _ (� CD <br /> OWNERS c(de� �� ss�-e Ala �sl�f�f!f TELEPHONE [7_ 3 Z 7— O•S� a <br /> v <br /> HOME ADDRESS <br /> r m <br /> EMERGENCY/FIRE NUMBER ROAD NAME 5p�- Cn <br /> `� T <br /> LEGAL DESCRIPTION (see tax receipt) C} 1 ) , RX t <br /> m <br /> TYPE OF PERMIT(S): DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTUREZ ADDITION ❑ PRIVY ❑ <)Cn c 0 <br /> cr <br /> FILLING/GRADING El CAMPING UNIT ElSUBDIVISION El � ZX/� a <br /> STRUCTURE/ADDITION USE: Rwoox-&-4 ✓I0 D /G(N( A'kkLh 111h0—0 6 KSt�&AJ(ASe- 5 5*` <br /> o_' <br /> Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: I WF►V�� ("�` ( r &, ? `� <br /> Gt tl ��•e1 . (�nt.7S i^ ✓�iV�l� Yi fl '�Vt'1'11.411.it irk <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR Q� <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T 3 3 W <br /> O — <br /> y <br /> DIRECTIONS FOR PLOT PLAN DRAWING• (AERIAL OR TOP VIEW) O <br /> CD <br /> m a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO Cl) 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N 0. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS 0 �JJJJ <br /> MUST BE SIGNED AND DATED BY THE OWNER. g o <br /> p � 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN O I� <br /> NEEDED. q M ll <br /> 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. 1 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 4, <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 <br /> SETBACK AREA. / <br /> 5. C� TG <br /> 6. 01' r ti.Cre j� 1::::ni Arrhll ILICM�OO(S G'r- �Jv�tc�c�T/on OM <' 3 :30 a � Innm 1 I ,< '0 am W �r. _ ;a <br /> ' M C W N o 7 <br /> 7. Z yV) o � co <br /> N : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of d � C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize cn m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m : p <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 <br /> CD <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> q m : <br /> SIGN HERE C( l' 'i r��Fwti , <br /> (Sig ure f owner or buiLdinrr contractor) (date) Y <br /> 169 <br /> ZONING ADMINISTRATOR --die <br /> En vi to fq fH 40 <br /> N N CT1 N N U1 Ut <br /> U7 tyl CT O O <br /> k TOWNSHIP PERMITS MAY BE REQUIRED �o a 0 0 0 0 0 <br />