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Builnett,Cl;unty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - c o <br /> ppp APPLICATION FORLAND USE PERMITS y. o <br /> OWNERq a /(y ` e ,� TELEPHONE 320 - Z 72/ <br /> HOME ADDRESS OR/ , Oyu / 7� 61- Q SS P� �� ~�Q3 9 <br /> // 0 <br /> EMERGENCY/FIRE NUMBER 32.0 •- 3 16 —2 7 2 I ROAD NAME Co- <br /> LEGAL DESCRIPTION(see tax receipt) 'V V ik4j 7�r 041 -SE <br /> DWELLING/BUILDING GARAGElACCESSORYSTRUCTURE ❑ ADDITION PRIVY ElA'49f� efr rn <br /> TYPE OFPERMIT(S): Jqurmt't� rr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> Co.,h�y L <br /> STRUCTURE/ADDITION USE: �a (� / .� �x 0 \ <br /> // (Home//Cabin; Commercial BB siness; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: 70l4rt' <br /> v <br /> V <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m0 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n <br /> m Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. t7 m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). y <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO to 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. 1 <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 n` <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS 'U <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN a ° l� <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. a <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 A HORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLES <br /> PERMITTED. U <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED HIN TH `I <br /> SETBACK AREA. <br /> 5. Ou <br /> 19 = 3d ACL <br /> 6. BV RNE 9g �' m o a _= 3 <br /> !!E7.,, � � mCH m > > <br /> AT(r"7. CvtouNTY : =_ y: :: m <br /> I declare that this application (including any accompanying schedule) has been examutet�Dy me and to the best of my G-c c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o L' <br /> all information contained in this application(including any accompanying schedule)and I further declare that Irecognize m m 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' <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other lkm <br /> authorized person to have access to thebove describe 1gernises at any reasonable time for the purpose of inspection. <br /> M :: <br /> m : <br /> w : <br /> SIGN HERE <br /> 40;1 V <br /> gnature of own r bull n r) (date) <br /> ZONING ADMINISTRATOR <br /> v�cnwwtnw� <br /> f�N N fT N N Ui IT <br /> VI IT O(T(T 00 <br /> TO SHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />