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Ma <br /> Barnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator ci z <br /> APPLICATION FOR LAND USE PERMITS 3 P <br /> r <br /> to O nn \\ <br /> OWNER RkC Qqi (/ * T3p,F L6t#-C+t �.(t'Srl �-- TELEPHONE 0 X-� <br /> HOME ADDRESS <br /> yds �o Ler <br /> P010-+ 14udso►ti �Jls 5,9616:- <br /> EMERGENCY/FIRE <br /> ,961 :- <br /> EMERGENCY/FIRE NUMBER y /S� ROADNAME / <br /> 1 <br /> nCM / I fa <br /> LEGAL DESCRIPTION(see tax receipt) �0+ 5 Uv/ L7 <br /> 7 Q <br /> 1 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION PRIVY El TYPE OF PERMIT(S): /` c 0 M <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> 5. <br /> STRUCTURE/ADDITION USE: P. Gu D UCG- gyis 7ns <br /> Cv Q4� ' 1F o , <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) y <br /> m <br /> BUILDING CONTRACTOR: Brux—,r Na c � <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR mCD n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. VMM_ <br /> N vV <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p m <br /> -n a <br /> oZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m I 73 t <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m V, v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF U� <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 1 <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 t <br /> MUST BE SIGNED AND DATED BY THE OWNER. S o <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q S Q <br /> NEEDED. 0 <br /> I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z p, <br /> CONDITIONS OF PERMIT: ' -XI <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT C J <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 1 G <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. <br /> X -0 °v' . 0 L <br /> m <br /> 6. � � ' n� x �- X <br /> 7. Z : '" m� <br /> o : M <br /> ly: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Qi c p <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of m 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 by the County of Burnett Wisconsin in determining whether to is- O <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am w <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 descri d premises at any reasonable time for the purpose of inspection. T <br /> m <br /> SIGN HERE <br /> (signa re of owne or uilding contractor (date) <br /> ZONING ADMINISTRATOR <br /> N NN Ol <br /> O1 U1 V1 O <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 00 <br />