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C j/t 6_�-) ),z/0 <br /> -Surneft County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator o hoz <br /> APPLICATION FOR LAND USE PERMITS 3. < <br /> .. r <br /> y O <br /> OWNER L re Jv��soti TELEPHONE 3 cly— 8, �M <br /> HOME ADDRESS le- "t <br /> EMERGENCY/FIRE NUMBER '� <br /> � 1 ROAD NAME W+ rl(am <br /> LEGAL DESCRIPTION(see tax receipt) S�a S/ ,V �A, r)k". �J en 41 <br /> 0 <br /> DWELLING/BUILDING ElGARAGE/ACCESSORY STRUCTURE El ADDITION <br /> ADDITION L19 PRIW ❑ Cn 0 <br /> TYPE OF PERMIT(S): Q <br /> FILLING/G7 NG CAMPING UT SUBDIVISION a <br /> STRUCTURE/ADDITION USE: vY G L �du J O 'f L// o C� <br /> (Home/Cabin; Commercial Busl ss; Bedroom; Deck;6tc.) rn G <br /> 13 r(� Th om�r <br /> BUILDING CONTRACTOR: <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 Cy <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m �? <br /> NORTH(N). C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF w Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 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. W <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. SU N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS C� <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: W <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT r <br /> ISSUANCE. <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. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> A � y ryO L <br /> 6. � vnyI ; <br /> v c a , 0, 3 <br /> 7. <br /> o <br /> 0) m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other f m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T <br /> m : <br /> L/-G-qV , <br /> SIGN HERE � <br /> (sig Lure of ow or Ilding contractor) (date) tt� <br /> ZONING ADMINISTRATOR Q: <br /> � CA <br /> CA01oC <br /> TOWNSHIP PE ITS MAY BE REQUIRED 0000 0 <br />