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Burned County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> F o <br /> OWNER ,)i QN Ij `T l— pIV <br /> TELEPHONE _� <br /> HOMEADDRESS 01,5155--a- <br /> EMERGENCY/FIRE <br /> 1g55-aEMERGENCY/FIRE NUMBER NA ROAD NAME iAtJ-Cii Qr�, <br /> NW <br /> LEGAL DESCRIPTION (see tax receipt) to-r i to {la E1�)Ar3D \ �fti�1�-p>TIO(J — V Mq�j pyU Cp 1 ID <br /> DWELLING/BUILDING §� GARAGE/ACCESSORY STRUCTURE 19- ADDITION ❑ PRIVY ❑ C/ 0 <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ �' <br /> STRUCTURE/ADDITION USE: YI9YYIFI CA6iP3 <br /> (Home/Cabin; Commercial Business; Bedroo ; Deck;etc.) m <br /> BUILDING CONTRACTOR: MELVIr� ELL.�-t <br /> CD �7; <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 �' <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> A m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0o <br /> T O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. mp <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> C n <br /> NORTH 0 <br /> 3. SHOW D M)ENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <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 O <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 6. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. `b <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. <br /> v <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. o ( �l <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. V\I d <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 ^ Q <br /> SETBACK AREA. <br /> 5. - rte=(1 <br /> m =.W W0CDa * m <br /> 6. mv aNy ^ � � <br /> 'a R00 0 � 3 <br /> Z ' <br /> N N <br /> 7. o m <br /> Cn <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G> 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 an accompanyingschedule and I further declare that I recognize <br /> PP (� 9 Y ) <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 relyin on this information I am ° <br /> providing in this application. I agree to permit county officials charged with administers r <br /> authorized person to have access to the above described premises at any reasonable time r tfi r f s i m <br /> Mt <br /> SIGN HERE �A(l i�.�d,�.� . 1�ry <br /> (signature of r building contractor) la ) <br /> ZONING ADMINISTRATORUOUN <br /> ZONING <br /> TOW HIP PERMITS MAY BE REQUIRED <br />