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BurnettCounty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> y O <br /> C <br /> f t` p N <br /> OWNER T.A-i'Ytp ISI TELEPHONE 'I '�Y�l " �IO Iq p <br /> `+- <br /> HOME ADDRESS ( <br /> �p <br /> (C <br /> EMERGENCY/FIRE NUMBER ROAD NAME Q�(� UI ed rC .. ch <br /> I <br /> C' . <br /> LEGAL DESCRIPTION (see tax receipt) 1'0—rI It� lY�r I se B.eac h `rmo n &i mew:&y <br /> y� a <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE:9 ADDITION ❑ PRIVY ❑ U0 <br /> TYPE OF PERMIT(S): cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ T. <br /> STRUCTURE/ADDITION USE: GIR <br /> N^ !je- c�7 qye-i q M <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 616 X 11 SHEET OF PAPER. PAY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> j <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) c <br /> 0 a <br /> O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 'A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m IF <br /> n <br /> NORTH(N). 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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. P <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 CIO <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS 0. <br /> MUST BE SIGNED AND DATED BY THE OWNER. o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o q�l <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 yN <br /> , <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER (q <br /> SETBACK AREA. ` <br /> 5. M -000.�COD ?gym <br /> 6. amcyo9' 3 <br /> Z : <br /> NQ <br /> 7. _m. <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G3 c <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 recognize 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 E <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 above described premises at any reasonable time for the purpose of inspection. -n <br /> m : <br /> m <br /> SIGN HERE <br /> 51 /q1q9 <br /> (signature owner or building contra r► te) ; <br /> ZONING ADMI STRATOR G/ ok w Fn cn w 49 <br /> N N VtNNN Vt <br /> Ut NOtT �OO <br /> 0 0 0 0 0 0 <br /> WNSHIP PERMITS MAY BE REQUIRED O 0 O CD 0 0 <br />