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BurnetOCounty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -00 Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> 5T 0 <br /> OWNERA I L Lee Jo�A24,) TELEPHONE 7�S_Z9��/Y 7�OS o <br /> m <br /> HOME ADDRESSl <br /> 0 <br /> EMERGENCY/FIRE NUMBER 7 7 T ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) Cl)-�7 J <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVYN <br /> ❑ o <br /> TYPE OF PERMIT(S): 1 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ d a <br /> STRUCTURE/ADDITION USE: 3,::Q. x <br /> (HonWQab,ia Commercial Business; Bedroom; Deck;etc.) co ul <br /> BUILDING CONTRACTOR: SeLE <br /> m <br /> m <br /> 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. TO m , <br /> M m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 1� <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <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. 31 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. �N C�6 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS ' 0 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 <br /> � o <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. n C <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: 0 <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 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. <br /> �l7-I�o� C -13 D W W 0 C a f m <br /> 6. m3 �amFnm � <br /> mcy `�' o' � 3 <br /> 7. o o <br /> o I :�'< <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) <br /> A <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of �� m m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize �� 0 <br /> CD <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 <br /> CD <br /> authorized Mon to h e access to the a#Qve described premises at any reasonable time for the purpose of inspection. . <br /> m E <br /> m <br /> SIGN HERE ,yam/ <br /> ( g ature of owner or#ERMITS <br /> tor) (date) i <br /> ZONING ADMINISTRATOR <br /> TOWNSHIPAY BE REQUIREkc V <br /> S <br />