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BurnejEounty 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator 3 <br /> �, Z <br /> APPLICATION FOR LAND USE PERMITS N <br /> ( 11 TELEPHONE <br /> OWNER 3(fC(-IL <br /> nr C*� t(iCA fPStlC/SIJ-�T S�/Oj/ ) - 7l)- Fi b- q1711LNb:.. �? 0 <br /> /0 �7 Ce W0- S5 k.- k" L m <br /> HOME ADDRESS ) '7 0 Wo 54 CoNa-ors L k <br /> ROAD NAME L-/. <br /> EMERGENCY/FIRE NUMBER 7 y 9a <br /> ur <br /> m <br /> n <br /> -� <br /> LEGAL DESCRIPTION(see tax receipt) PRIVY a <br /> GARAGE/ACCESSORY STRUCTURE IDI ADDITION ❑ or <br /> DWELLINGIBUILDING ❑ o` <br /> TYPE OF PERMIT(S): CAMPING UNIT ❑ SUBDIVISION ❑ T. <br /> FILLINGIGRADING ❑ 11 p 0 (h <br /> STRUCTURE/ADDITION USE: <br /> p Q )nZd j�OrE1 e ` CfSGrR m \�/ <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc. � <br /> BUILDING CONTRACTOR: v <br /> m <br /> In 3. <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81A X 11 SHEET OF PAPER. ANY INCOMPLETE OR 0 m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p a <br /> DIR CTION FOR P OT PLAN DRAWINIC. (AERIAL OR TOP VIEW) m p <br /> C 0 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. _ O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m v <br /> NORTH(N). LOT Z <br /> 3 CEN DI NE OF NS INROAFEE BUILDING(S)MEASUREMENTTOTHEORDINARYHIGH WATERMARK(OH(WM)OF o <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> 4. SHOW THE LOCATION OF THE WELL(W).SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO N C <br /> BUILDINGS,ROADS,LAKE,LOT LINES. 7 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILL O <br /> 6, IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS O ` <br /> MUST BE SIGNED AND DATED BY THE OWNER. m <br /> 4 / <br /> O AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SZ `f <br /> NEEDED. P <br /> THIS PERMIT IS SUBJECT Tt <br /> O ALL CONDITIONS LISTED BELOW. <br /> I <br /> vjQ T,nnic nG PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT i <br /> ISSUANCE. IG OF TREES AND <br /> IS <br /> 2.3. REMOVAL OR CUTTISNO GRADING OR SHIORELAND ALTERATIONS ARE ANLOWEDT UNLESS SPEC F CALLY LIN. <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALL WITHIN THE REQUIRED WATER ;a v n <br /> SETBACK AREA. p 3 a toad. <br /> c `." 0 i <br /> N O <br /> Z : N N Q <br /> 6. <br /> (�C <br /> 7. me and to the best of my Q <br /> accompanying schedule) has been examined by o.C , <br /> I declare that this application (including any m m <br /> schedule)and I further declare that I recognize L) <br /> knowledge and belief it is true,correct and complete-a nykaccompanying dge that I am responsible for the detail and accuracy of <br /> all In contained in this app the County of Burnett Wisconsin In determining whether to is- <br /> 9 <br /> that this information I am providing will be relied upon by <br /> officials charged with administering county ordinances or other <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 /> in this application. I agree to permit county remises at any reasonable time for the purpose of inspection. ID <br /> providing . <br /> authorized person to have access to the above described p 4W : <br /> (date) <br /> SIGN HERE <br /> (sign a ure of owner or building contractor) <br /> �40 A 4ft 4L44 <br /> N N NU, pip <br /> N N <br /> ZONING ADMINISTRATOR 6 0 0 0 0 <br /> 00000, <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />