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C}2 u l gra <br /> .jrnett 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 /> rn � <br /> 41 <br /> p' C <br /> OWNER GJ A /-�. S AS O /J TELEPHON(6/ /�) ���� 3 n <br /> HOME ADDRESS 63& 01�R () i~¢. A-2 v <br /> 1 <br /> EMERGENCY/FIRE NUMBER n �� i �T 2 sfe2 r- ROAD ME �n 4! / V-1f� �— T jw ��' , / G I P,46.5 s <br /> LEGAL DESCRIPTION(see tax receipt) / d e. s./�'� 3 Y l v b l' r �y� ZY� c <br /> Qt <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION PRIVY ) c 0 <br /> TYPE OF PERMIT(S): ❑ cr <br /> FILLING/GRADING ❑ ❑ SUBDIVISION CAMPING UNIT <br /> aX y. <br /> STRUCTURE/ADDITION USE: 3������ � <br /> (Home abin; Commercial Business; Bedroom; Deck; etc.) C <br /> BUILDING CONTRACTOR: <br /> v <br /> 1 <br /> M <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> n a <br /> T O Z <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 <br /> C o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m `� ` v <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 w <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. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN cr <br /> W S t NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: n <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 9wl <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. J 1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. V� <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. tCA-r a'/ rr t-�p-}� , 'd "1 / u Yt y� '0 y w ��n O m <br /> 6. �.� y t)` l/'� `„ - rlvl C�J ' s ' �r�y� h el <br /> U � � �CD C=10 0 0 _ <br /> 7. O <br /> G <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> IS <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of c 0 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m In <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 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 c <br /> authorized person to hav cess to the abiwe described premises at any reasonable time for the purpose of inspection. <br /> M <br /> CD <br /> SIGN HERE <br /> (signatur of owner or buildin o tt cttoorr)� (date) <br /> ZONING ADMINISTRATOR \M <br /> cn W16 61 cn t» <br /> N N (TNN(T (T <br /> V1 (T O N V1 O O <br /> q0W' NSIHIP PERMITS MAY BE REQUIRED 00000000 <br />