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Bu�flett 6unty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N O <br /> c <br /> n <br /> OWNER f TELEPHONE <br /> coca ('f 2r VA/fib r / <br /> HOME ADDRESS /33 O d' y �(�-L� -4r ez-, .Prf7 &J 65937 �l <br /> EMERGENCY/FIRE NUMBE ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) i m <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ vl C <br /> TYPE OF PERMIT(S): or <br /> FILLING/GRADING ❑ CAMP G UNIT ❑ SUBDIVISION /❑ S. <br /> STRUCTURE/ADDITION USE: 0-�� �Lr X �� o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) uN, <br /> BUILDING CONTRACTOR: <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O y <br /> ;a c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 Q <br /> 7! 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 C) <br /> NORTH(N). N O <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. ° <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 <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. 20-1 <br /> `) <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q ° V f <br /> NEEDED. W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. i <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 /> 4. NO STI UCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE RE( <br /> SETBACK AREA. - <br /> 5. a© �r� V _ D si m <br /> o <br /> 7. v v �9( Gm eURN� J ��v 1° N 2M v, m <br /> I declare that this application (including any accompanying schedule) has been examined by t of y c� C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the � cy o a g <br /> all information contained in this application(including any accompanying schedule)and I further declare at I recognize m m rAn <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m 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 ; <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 /> SIGN HERE C' 2- a3 - 99 ' <br /> (signature <br /> f owner or building ntractor) (date) <br /> ZONING ADMINISTRATOR . ' ' . . . <br /> 40 w 49 40— <br /> N NOS NNNtT <br /> 01 V1 O Vt V7 O O <br /> O 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />