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Burnett Count 7410 Co. Rd. K No. 102 Siren WI 54872 Office of Zoning Administrator Y , , g st ator 0 z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> Q-QrNa..ev�� 2'1 1 E. ll r.//f�s (- �t �'�ti� is ( / �"�o�535�Y3oy� Vr 5 <br /> OWNERNE TELEPH <br /> Oe V� <br /> Tr�nEll , .\5-07 7✓`/—,3(,0 <br /> HOME ADDRESS �� j\ S4oQ►�2r� W �� 0C <br /> 1 <br /> 0 <br /> EMERGENCY/FIRE NUMBER acar� <br /> I a ROAD NAME T o <br /> llr. 1 <br /> LEGAL DESCRIPTION(see tax receipt) L O 3 I ac k 3 ��� ck� .� L— c <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> 11,/ y m <br /> STRUCTURE/ADDITION USE: D-P-ch ir-e p(".e, e X \.5�i+�a 0 X aq � S r e— c IC h, <br /> (Hom /Cabin; Commercial Busi s; Bedroom; Deck; etc.) y <br /> �(7 m <br /> BUILDING CONTRACTOR: 6 rl li r I(• 15 Skid <br /> m <br /> m <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. T <br /> y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <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 ~' B <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. p <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. C) <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR,ETC.,THE PLANS 0 SU <br /> MUST BE SIGNED AND DATED BY THE OWNER. F <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN N o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 0 <br /> (y <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ) d <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 SPECT LLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN TER <br /> SETBACK AREA. <br /> CD <br /> 6. o.K, -b) r laces .5am� s/2� d CD a 0 F a <br /> y X6 7. e o fig amide. "vvZ N <br /> - � : m <br /> I declare that this application (including any accompanying schedule) has been exam) bpd to theof my 6 p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am respons •M,�-p��{�af�l racy of W m <br /> all information contained in this application(including any accompanying schedule)an I rt15A1t11eclare"tfiat I recognize a, : M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- CD <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other In <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. `D <br /> If <br /> CD <br /> CD <br /> SIGN HERE D <br /> (signature ner or building con tr rte) (d te) <br /> ZONING ADMINISTRATOR <br /> TO NSHIP PERMITS MAY BE REQUIRED <br />