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Rurriett Zounty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v OZ <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> _ r <br /> y O <br /> c <br /> N <br /> OWNER 4 k �_&x.1 U10/){,,CK( TELEPHONE <br /> HOMEADDRESS St, IAtNrJLS CdA)LJ-eh7T4 o2oS c-,&&c(f <br /> 517TAA-ea e,� . e S r-S�oxr <br /> CD <br /> J41` , r <br /> EMERGENCY/FIRE NUMBER ROAD NAME (y02 ��jt'r� rg <br /> o <br /> 5 c c- 3 q -7-Lo P 1 2 1(`o t.3 C� <br /> LEGAL DESCRIPTION (see tax receipt) ' j V//Z G i p 7� Z rn <br /> DWELLING/BUILDING 9 GARAGE/ACCESSORY!STRUCTURE ❑ ADDITION ❑ PRIVY ❑ rq 0 <br /> TYPE OF PERMIT(S): <br /> v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) m <br /> BUILDING CONTRACTOR: irG O(4) CCSIVCT. <br /> M <br /> CD <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. m <br /> O e <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> m a <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. r1 o0i <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m :° <br /> NORTH(N). <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 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. SU <br /> S. 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 I <br /> MUST BE SIGNED AND DATED BY THE OWNER. c <br /> 111 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN Cr <br /> NEEDED. —ny <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c 1 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 9 �'p; <br /> ISSUANCE. 1J ,I I i <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. p <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER ill <br /> SETBACK AREA. <br /> 5. <br /> t�A .0 0 m O L <br /> M � 3 am 9 A <br /> N: m <br /> 6 <br /> 7. Z y �� ' M <br /> 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 c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m S <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 Ims'p9jisin in determining whether to is- O <br /> sue a permit. I further accept all liability which may be a result of the County of do,�� ation I am > <br /> providing in this application. I agree to permit county officials charged with 1 e g�ty\Cl/d1 s or other m <br /> authorized person to have access to the above described premises at any reas na e u o inspection. -n <br /> Allm : <br /> SIGN HERE <br /> MAR S9 <br /> (sign�of own or building contractor) (dat <br /> ZONING ADMINISTRATOR �/i Flaf) RURNETT COON . . . . <br /> ' fn yr fn yr fn fn- <br /> N Nn1 N <br /> PP53 C3 <br /> (1� O V1(T O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br /> 0000000 <br />