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I4 <br /> Furnetf County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -CD o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r (1 _ <br /> J <br /> N ,�. x <br /> OWNER �pCr� MQv\SPn TELEPHONE 3`(9^��3a O � C*O <br /> _ II Q/� (( m �n <br /> HOME ADDRESS a SUS(� ( rJ t 1 QPY4 �Cx (� Q Wo r L.L� 5 �(��3 <br /> u Mpo rn <br /> EMERGENCY/FIRE NUMBER �(� 1� ROAD NAME <br /> S-3 S- T 3 9 - <br /> LEGAL DESCRIPTION(see tax receipt) ot✓ L O-t $ y ( w 'S <br /> O <br /> DWELLING/BUILDING 0 GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ fn � <br /> TYPE OF PERMIT(S): a ' <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: m S <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) m <br /> r <br /> BUILDING CONTRACTOR: ©Cru <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 6'/z X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <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. `z <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. �j N Do <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS J <br /> MUST BE SIGNED AND DATED BY THE OWNER. 1 to o <br /> C O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN 0 ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <br /> � I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT S <br /> ISSUANCE. ( p p <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG$H11r _ C <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFIC LLY.('7! <br /> PERMITTED, L ; C n <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN`PfiE REQUIRED WATER - <br /> SETBACK AREA. ZL � r � m <br /> _ d <br /> O7. ' <br /> P <br /> 1 declare that this application (ncluding any accompanying s ule) has been examined by me and to the best of my (j= p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of n 0 c <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- D <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 m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T <br /> CD : <br /> ro <br /> SIGN HERE ^� V 6 <br /> (signature of ow building contra r) (date) <br /> ZONING ADMINISTRATOR to <br /> 9 to w w cn'A <br /> l NM N NN CA <br /> Ln 0 (n(T OO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />