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ounty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 'U o° o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> '7'13--dao y-515 y <br /> OWNERTELEPHONE <br /> NIIcF� �� t 1'°lo�. rto� asg. ye 79L <br /> A-7146) noq si0te W., Ch lCo, -- MoD (oaS 0 <br /> HOME ADDRESS�a 7 �� Cc t o P n ^ <br /> OQ r m <br /> EMERGENCY/FIRE NUMBER . , ROAD NAME �P S:s/e -- <br /> LEGAL DESCRIPTION(see tax receipt) PA R �� # U &— R �7S`d� �s V O 4>0 <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ y 0 <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADINGS� (❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5, <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: M Y S 61 i:- <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p .� <br /> 70 (� <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T CL <br /> Q <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> p <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Q c <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 1 <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 /> 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 ?, <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN Cr <br /> 0 S <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o O <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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 /> j��// � mCm o53 <br /> N zi O O f0 <br /> 7. ? CD <br /> � � : <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 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 I 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. T <br /> m : <br /> CD : <br /> SIGN HERE <br /> (signatureof owner <br /> �orjbuilding contractor) (date) <br /> ZONING ADMINISTRATOR of I/n i IIQ� 1 <br /> wwcnwww <br /> N N01 N NOI Ol <br /> Ot V7 O Vt V7 O O <br /> '0000000 <br /> TOWNSHIP PERMITS MAY BE REQUIRED '0000000 <br />