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BurCett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator v c) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> fn O <br /> H <br /> OWNER t✓O 0 e� TELEPHONE/"/,4g/> O \ J <br /> HOME ADDRESS G 2p (,l!g, <br /> r m <br /> EMERGENCY/FIRE NUMBER LS 74 ROAD NAME n <br /> 'S-T�v u.�J SO <br /> LEGAL DESCRIPTION(see tax receipt) �j4 �7477 030 elllf) I �� � O <br /> DWELLING/BUILDING 11fGARAGE/ACCESSORY STRUCTUREOv ADDITION ❑ PRIVY 1:1Cn o <br /> TYPE OF PERMIT(S): C <br /> FILLING/GRADING ❑� CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) cn <br /> BUILDING CONTRACTOR: t�GcJr�E�, iu <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 "� <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> O <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O � <br /> n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T Z <br /> 0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m p <br /> NORTH(N). C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO M v <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. c <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. <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. 06 o <br /> v 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q o, <br /> NEEDED. T �v <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z 1 1 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Y� <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. op / <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 0 , <br /> PERMITTED. f <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. S,/ � <br /> rT�rce (,( ;ov0 ;� o�vv <br /> 6. CD <br /> 21. CLQ Ta M <br /> N C N N o > 3 <br /> 7. Z R 7,9 q <br /> A <br /> = y : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- p <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 /> providing in this application. I agree to permit unty officials charged with administering county ordinances or other <br /> authorized person t have access to the a CD <br /> ve scribed premises at any reasonable time for the purpose of inspection. <br /> Got Am <br /> M <br /> N HERE i _ �"� zo©Q cn . <br /> (sign re of ow r bui di c actor _ (date) <br /> ZONING ADMINISTRATOR <br /> 4.9 <br /> J 696446, <br /> N NOON N NN <br /> TO SHIP PERMITS MAY BE REQUIRED Ut Ot001 N 00��f�b o 0 0 0 0 o O <br /> o(,`I 0000000 <br />