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Burn**County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 c1 Z <br /> APPLICATION FOR LAND USE PERMITS 3 P <br /> OWNER JQmeps I �� TELEPHONE ���5 77_ �3LI5' O <br /> HOME ADDRESS Z16,-2& 1 J VC, le— 4ve, lV OQ keWe mv ss�a <br /> EMERGENCY/FIRE NUMBER �yo� �K� �� ROAD NAME ?& Z Ike �� _� (� � <br /> �/ ) Q �y//-- //f� L} <br /> LEGAL DESCRIPTION(see tax receipt) /Q.�. T (I01- � f A / (>7 /VF l(fL- 07/ — q—/'5- <br /> N <br /> IN <br /> 8 2� <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE 1® ADDITION ❑ PRIVY ❑ m o <br /> TYPE OF PERMIT(S): On <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION Ela <br /> ell <br /> � <br /> �rxau/ N <br /> STRUCTURE/ADDITION USE: 712rA�,i~. O o' <br /> Home/Cabin, Commercial Business; Bedroom;Deck;etc.) ti ' <br /> BUILDING CONTRACTOR: I I. . S <br /> lir <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. G 3. <br /> DIRECTIONS FOR PLOT PLAN DRAWING, (AERIAL OR TOP VIEW) 0 m <br /> O m <br /> m CL <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m o <br /> NORTH(N). <br /> 3. 'j 0 <br /> 0 <br /> 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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 0 c <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO f ,� <br /> BUILDINGS, ROADS,LAKE, LOT LINES. \N <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <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. c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a 0 <br /> NEEDED. <br /> 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT �{ <br /> ISSUANCE. (v`( <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 <br /> SETBACK AREA. <br /> 5. <br /> r ca <br /> 6. <br /> c W M 3 <br /> 7. Z ; m o '00 - <br /> o �'� <br /> I declare that this application (including an accom an In schedule has been examined by me and to the best of my 6 co ip <br /> PP ( 9 Y P (Ing ) Cr <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m C_ <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m 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 I am m <br /> providing in this ap ation. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person o ve access to the v described premises at any reasonable time for the purpose of inspection. <br /> mCP ' <br /> SIGN HERE <br /> (-ggn(a"t'ur f ner or bul ding contractor) (date) <br /> ZONING ADMINI RATOR !J l <br /> w w w� <br /> N N N N N <br /> TOWNSHIP PERMITS MAY BE REQUIRED o o N o 0 <br />