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Burriett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS 3 ` <br /> C A <br /> D `0> <br /> OWNERr,T=� 1sCA�o��k i TELEPHONE 105^5 <br /> V— <br /> MAILINGADDRESS Dgf�cbl rL4 I'n ��s3� FO� <br /> 6J�( CD <br /> r CD <br /> PROPERTYADDRESS <br /> N '�aSEvySEt4SFYy � <br /> LEGAL DESCRIPTION(see tax receipt) co <br /> m <br /> L_ ` 2 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ �� 5"'bhEi` U) o <br /> TYPE OF PERMIT(S): ��I rOwvwSh �orR -U1e n <br /> FILLING/GRADING ❑ CAMPING UNIT SUBDIVISION ❑ lyi�r\tT-�ya4� c N <br /> STRUCTURE/ADDITIONOSE: ' o <br /> (Home/ in; ommercial Business;Bedroom; Deck;etc.) y <br /> /h <br /> m <br /> BUILDING CONTRACTOR: C`pr�c s <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 61/1 X 11 SHEET OF PAPER. ANY INCQM2} OR _ 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. ?� -O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) a <br /> L <br /> a <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCA ee''!! a 20 <br /> JL <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEI ILDIN li))/tNOCw�CATE <br /> NORTH(N). <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINEBkffiNQQ®®Ifp ITM m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER Mf6fkIWaA <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 1vI�lVV�Lii 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 <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. o <br /> v e` <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN � XJ <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P , <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I <br /> I <br /> ISSUANCE. P OC <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Q <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY G <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. ,^ ,/ r <br /> N W0 ODaO M <br /> m <br /> B am � a1D A <br /> 6. a mcN !" a � 3 <br /> 7. Z N = O <br /> O -n : : : <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my — T : A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m a in c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m � o v <br /> that this information I am providing will be relied upon b the County of Burnett Wisconsin in determining whether to is- m <br /> P 9 P Y tY 9 G): <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 describlo premises at any reasonable time for the purpose of inspection. m <br /> m o : <br /> r m <br /> SIGN HERE <br /> (sig own or building contracto date a <br /> ZONING ADMINISTRATOR <br /> fA fA fA fA � N <br /> N V t N N O O <br /> NO (T (TOO <br /> TOWN IP PERMITS MAY BE REQUIRED <br />