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DIA0y <br /> Elvrneft County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator G) z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N <br /> ' C <br /> C/YCt_ 1D3 --4 ? /] n <br /> TELEPHONE <br /> 7 , ,Q v <br /> HOME ADDRESS I L � 3 bu e r k PJ — Edet I <br /> r m <br /> EMERGENCY/FIRE NUMBER ROAD NAME W ��1 R <br /> j / c <br /> LEGAL DESCRIPTION(see tax receipt) (Orl 1 lr S y t U. 1� QL 3 G L W y <br /> Slzzz�'e <br /> DWELLING/BUILDING Rr GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ m <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ q <br /> STRUCTURE/ADDITION USE: 1 tOm� t S'�G��Y� <br /> T. <br /> (Home/ n; ommercial Business; Bedroom; Deck;etc.) m <br /> 30}>�, I,t•i)lam <br /> BUILDING CONTRACTOR: lir <br /> v � <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> o y � O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> m a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m v� <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m ? Q <br /> NORTH(N). C on <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 \ 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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN Cr <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 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. l <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOW WITHIN THE REQUIRED WATER <br /> �SETBACKAREA) >�^ <br /> 5. ]VL1hlr� (REA ��CJ S <br /> (D 0X 'o0 CD <br /> O O <br /> 6. 0 <br /> CD 3 2L CD <br /> MCPS 0 > <br /> N <br /> 7. 0 <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 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognizeCD m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- y p <br /> ti <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 pd m <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other ? m E <br /> authorized person to haye access to the above descr' ed premises at any reasonable time for the purpose of inspection. T <br /> CD <br /> m <br /> SIGN HERE <br /> (signa ure o ov`ner or building co t ) (date) <br /> t <br /> ZONING ADMINISTRATOR LI <br /> f»wcnucnw-+ <br /> N N N N CA Ln <br /> u7 V70 Ut Vt0O <br /> dWN' SHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />