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Bdrnett Cbunty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator _U 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> fn O <br /> H <br /> C <br /> OWNER jd /9" xo TELEPHONE <br /> . J r <br /> HOME ADDRESS d( <br /> v � �p�/ tle Xj 647 <br /> Plom <br /> EMERGENCY/FIRE NUMBER �5 � ROAD NAME <br /> ,nE3>Il►i2V.� 5�'8 f1,e14Pay del. 6ou. nor <br /> LEGAL DESCRIPTION (see tax receipt) d-77—i( —3S -o .�LY00 (�-197 It) /2, /3) <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE CJ ADDITION ❑ PRIVY ❑ o (n 0 <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> 5. <br /> /' N <br /> STRUCTURE/ADDITION USE: oQ py++C /y�,.t� '— 7PJ1 1e ' — 1 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) rn <br /> m <br /> BUILDING CONTRACTOR: /l�*QK ria, <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. n — <br /> O <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n a <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m ° p <br /> NORTH(N). <br /> 0 <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 1' <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. o <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 /> S. 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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> v � fft'� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED. Cr0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z �) <br /> CONDITIONS OF PERMIT: Iv111 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. V <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 <br /> SETBACK AREA. <br /> 5. a �- ;av0r- o�ov <br /> m �• w � m m <br /> 6. a � a`�^ i ' 3 <br /> 7. <br /> P <br /> = CO m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my L7 c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of w C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m m <br /> that this information I am providing will be relied upon byAls <br /> of Burnett Wisconsin in determining whether to is- p <br /> sue a permit. I further accept all liability which may be a t of Burnett relying on this information I am m <br /> providing in this application. I agre o permit county ofd tering county ordinances or other m <br /> authorized pers ha access t he abo ribed apY r a. I purpose of inspection. T E E <br /> m <br /> m : <br /> SIGN HERE :7' <br /> (signat of nero ng contra or ool (date) <br /> ZONING ADMI TRATOR \ <br /> to to to to.. <br /> N NN N N (N(T <br /> Z01V,^,^ �N1Y �i5�3 !fid N^p ; � o0101o <br /> T NSHIP PERMITS MAY BE RE(291RED &85V G,-, 45 0 0 0 0 0 �o <br />