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Barnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator w-0 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 ° <br /> T � � <br /> OWNER TELEPHONE <br /> HOME ADDRESS /2V <br /> "Rtn ROADNA <br /> EMERGENCY/FIRE NUMBERASy 1?y'q; C n/QC/ D ; MC�J <br /> LEGAL DESCRIPTION (see tax receipt) Cn <br /> pC pU <br /> i <br /> TYPE OF PERMIT(S): <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE, ADDITION PRIVY ❑ <br /> C <br /> FILLING/GRADING 9 CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: /DX28 ddd doh OV7 QO✓CA22,02 gN�Vg e �w. LL <br /> bT(d' 0 <br /> �,c� y—,`(Hom Cabin; Comm rcial Busi ss; Bedroom; D ck;etc.) ' Nvnde,t'K�J Cn <br /> BUILDING CONTRACTOR: /✓�<t° Jam/s/D g/ =f✓/// (OOvor//., yam Jilt f/Jjy yi f{/y POwl 2. <br /> 7j3 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 V <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> '0 uN <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O � <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n o A ( <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m l��I D <br /> NORTH(N). <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. 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. N <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. \ N O <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. -I O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o -� <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS jRELIPg <br /> IOtF� U1 <br /> ISSUANCE. �S� V <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIF1 <br /> PERMITTED. ' 0 �) <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN TH D��; 0 <br /> SETBACK AREA. "7/ J <br /> 6. Vf `SL�c✓ /Lo� /�/ �/U/yy LpJ^Sll/ )�8 ei Y�O�•Y m - d°r' > Oaf m <br /> �Q�� 0./1/a(61L.. p OL C�/��' 'E;/ (� ,T�• m 3 n m 0- a cD .� <br /> / .o : m C y m 0 = 3 <br /> 7. Z in ID 0 <br /> o -n• <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> PP (including Yaccompanying ) g \ <br /> all information contained in this application Includin an 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- m <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 O <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to hayq access to the above described premises at any reasonable time for the purpose of inspection. `D <br /> q m <br /> SIGN HERE ZOd/ 6 <br /> (signature of owner or building contractor) <br /> (date) <br /> 3^ . <br /> ZONING ADMINISTRATOR <br /> if1�1G G� <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />