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Burned County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o° o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> NO <br /> c t� <br /> OWNER D.Lifer It ! TELEPHONE ?/j— lG bio © o <br /> HOMEADDRESS `� <br /> CT 0 <br /> EMERGENCY/FIRE NUMBER 30 3 ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) kS kI e5 — // m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ <br /> TYPE OF PERMIT(S): o- <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ S. <br /> � �1 <br /> STRUCTURE/ADDITION USE: Q✓.o�' 2 x16 S. <br /> 0 <br /> (Ho /Cabin; Commercial Business; Bedroom;Deck; etc.) <br /> BUILDING CONTRACTOR: O iv Al e— A-� <br /> m � <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). to o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m , �a <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. �P <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO O <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 /> 01 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN ° <br /> NEEDED. C <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. /WI <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. (vQ <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. p v 0r-(p� 00 <br /> v aye. .'G <br /> m <br /> $ � <br /> 6. � � m c N . 0 5 3 <br /> 7. _ <br /> Py; ': m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G3 c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ; a e , <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize Q m 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 1 am �? <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. -nj m <br /> CD <br /> SIGN HERE LF-- <br /> (sign ur f pwner or building c r ctor) date) <br /> ZONING ADMINISTRATOR wv+wv+wv+� <br /> � NONCNI100 <br /> 0 0 0 0 0 0 0 <br /> OWNSHIP PERMITS MAY REQUIRED 0 0 0 0 0 0 0 <br />