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lett tnunty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator M <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> iNER 41 + a TELEPHONE �'71,r- <br /> ✓NER P .F n r��� ��JJ/ O <br /> '^�' =? O <br /> 30 <br /> HOME ADDRESS 17� t°i 1/V r- 0 <br /> EMERGENCY/FIRE NUMBER F�7� ROAD NAME 7 <br /> Cn 14 <br /> LEGAL DESCRIPTION(see tax receipt) Pd , l XJv lL, toT 1-7-4-15- <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE LI ADDITION ❑ PRIVY ❑ c 0 <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑/T CAMPING UNIT SUBDIVISION ❑ y. <br /> STRUCTURE/ADDITION USE: P o <br /> 1" <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) m <br /> In <br /> BUILDING CONTRACTOR: �wt:� fir <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n a <br /> -n O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m o <br /> NORTH(N). y <br /> 3. 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 Z <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 <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 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a 0 <br /> NEEDED. <br /> Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. P I <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Jj , <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 Is' <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. ;0 _-00d it0oC m <br /> 3 nm wa..r-;a <br /> wo Ifo q <br /> Z : N �.< <br /> Cr <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G3 ID <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of n I, <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- <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I amCO <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have acce s to th b e described premises at any reasonable time for the purpose of inspection. <br /> M : <br /> SIGN HERE <br /> (signature of owner or ng contractor) (date) <br /> ZONING ADMINISTRATOR <br /> fNT PO0 (N7100 <br /> O 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED o o <br />