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C�/?ct7" <br /> Burneft'±ounty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v L7 z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> a <br /> OWNER �'C TELEPHONE16�� M� <br /> HOME ADDRESS ,. OU <br /> N <br /> EMERGENCY/FIRE NUMBER p ROAD NAME ( ' <br /> LEGAL DESCRIPTION (see tax receipt) NLe—/V oZ�— _A0 _Q m <br /> m <br /> I a <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITIONPRIVY ❑ m 0 <br /> TYPE OF PERMIT(S): o <br /> FILLING/GRADING CAMPING UNIT 1:1 SUBDIVISION ❑ //� y / c <br /> STRUCTURE/ADDITION USE:�� <br /> (Home/Cabin; Commercial usiness; Bedroom; Deck;etc.) <br /> dC m <br /> BUILDING CONTRACTOR: Ar <br /> v <br /> W <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. <br /> O <br /> ja <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n oOi �p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m :? <br /> NORTH(N). N c <br /> 3. SHOW DIMENSIONS 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 <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 <br /> BUILDINGS, ROADS,LAKE, LOT LINES. ) <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. fV <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. too I <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q S t n <br /> NEEDED. v' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> o N <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT orot <br /> ISSUANCE. N <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 614 <br /> nn '' <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY V J <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> -udd o � Fov <br /> 6. 0' mC01 0 ' 3 <br /> 7. p R N C 710 =j <br /> = y : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true, correct and complete. i acknowledge that I am responsible for the detail and accuracy of o C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m ;a <br /> that this information 1 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 <br /> providing in this a ati In ree to permit county icials charged with administering county ordinances or other m <br /> authorized pe to the es -n <br /> remises at any reasonable time for the purpose of inspection. T <br /> q <br /> 2 I-le"I000 <br /> SIGN HERE <br /> rature owner r uilding contractor) (date) <br /> ZONING ADMINISTRATOR • • . • . . v, <br /> 40int4W40�A� <br /> N N V1 NN in CT <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />