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&fie ,a <br /> Burneft County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator M o 0 <br /> APPLICATION <br /> /FOR LAND USE PERMITS 3lgelz"O-17CD. <br /> N <br /> OWNERy1y/L�/%Gt/�!✓ � �C�L �� /1f,,'�EPHONE7 , <br /> HOME ADDRESS (S �� piJJO/' (ej <br /> EMERGENCY/FIRE NUMBER o ROAD NAME <br /> J <br /> LEGAL DESCRIPTION(see tax receipt) <br /> m <br /> a <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ , rn <br /> TYPE OF PERMIT(S): C ii <br /> FILLING/GRADING ❑ CAMPING UNIT M' SUBDIVISION ❑ <br /> ' / <br /> STRUCTURE/ADDITION USE: ��� � \ <br /> / X ')e / �T� TT n <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) rn <br /> BUILDING CONTRACTOR: <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p v <br /> x N (A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T o v <br /> O Z <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 <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> v <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. <br /> 5. 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 c JU <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 4 <br /> NEEDED. l l <br /> \U <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o C <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 /> m . m m m <br /> 6. m c 1 y o 3 <br /> ,„ N O 7 <br /> ? D <br /> 7. o '� : <br /> — m : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my L7- 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- O <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 ove described premises at a y timafoFth parpose of inspection. T <br /> m E <br /> SIGN HER <br /> (signature ofo or building contra to (date) <br /> ZONING ADMINISTRATOR <br /> /N <br /> M (l� O M CA P (J1 [T O O <br /> N PP <br /> TOWNSHIP PERMITS MAY jWF1-ffE6®UN 1 l (�0 0 0 0 0 0 0 <br /> 0 0 0 0 0 0 0 <br /> ZONING <br />