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671 C" <br /> BNrnett C..unty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator - 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> OWNER/Y I -P til_ L j j%&j S d/� TELEPHONE 7/!C—.a9A/- X965— O a <br /> HOME ADDRESS�jZy6 .4d If �„p f o CC2d d L4-tr Sqa Z6 v � <br /> r m <br /> EMERGENCY/FIRE NUMBER 6,771f ROAD NAME 4h3t,, rel k, <br /> LEGAL DESCRIPTION(see tax receipt) <br /> SWSF co <br /> CD q <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE-ADDITION ❑ PRIVY ❑ U) 0 <br /> TYPE OF PERMIT(S): cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> H <br /> STRUCTURE/ADDITION USE:_ � � /�-Cr{Ip7= <br /> (Home/Cabin; Commej6ial Business; Bedroom; Deck; etc.) ur <br /> U <br /> BUILDING CONTRACTOR: �C�-n (���, <br /> 2. <br /> v � <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T 3. <br /> O <br /> x N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> CD <br /> -n o. e <br /> n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2 THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C <br /> NORTH <br /> n <br /> ( ) <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO M B <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 a8 <br /> BUILDINGS, ROADS,LAKE, LOT LINES. <br /> S. 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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN oW <br /> Cr S, ,l�J <br /> NEEDED. 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z W <br /> CONDITIONS OF PERMIT: P <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I <br /> ISSUANCE. I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. r,, <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ,lJ <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> zv 'r- M0 <br /> 6. U� �yyl`.��J m n Ow x <br /> CD C y y C <br /> 7. Z y N � O <br /> i <br /> O Z?j'< <br /> = Cn m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of i mq C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize w. <br /> Ak <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- I�,n 3 m 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 co ty officials charged with administering county ordinances or other 1 <br /> CD <br /> authorized person to Jia cc s t above sc ibed premises at any reasonable time for the purpose of inspection. <br /> m <br /> M <br /> SIGN HER <br /> (signs re f owner or building contractor) (date) <br /> ZONING ADMINISTRATOR `ve <br /> / <br /> W 169 W� <br /> N NNNN ()1 fT <br /> V7 Ut O V7 fT O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />