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Burthett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> 0 <br /> n B. o r11 <br /> OWNER er mar u r�� / a Z e TELEPHONE ��G —�� X'nl <br /> HOME ADDRESS g g V9 /V• Ifll r /�U Af, Jtr U&- 5q(J v <br /> EMERGENCY/FIRE NUMBER 8 ROAD NAME /�e,- Ad �m <br /> V <br /> // q I <br /> LEGAL DESCRIPTION(see tax receipt) ,�.� �lO— 1— <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ® PRIVY ❑ Co <br /> TYPE OF PERMIT(S): C <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ LA <br /> a <br /> STRUCTURE/ADDITION USE: R P cl rrJ !) Put �>)X� 7 / rc� �/ C�U S <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) ur <br /> m <br /> BUILDING CONTRACTOR: ,��.� l <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C <br /> NORTH(N). y <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO rn <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. 1 A <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. l 1 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ly <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. <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHENCr <br /> NEEDED. <br /> VJ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. : O' <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE RE UIRED WATER <br /> SETBACK AfZEA. <br /> l n / lam! <br /> k1°7-Con�a/-i,�,'n due. K�lcGf Se c <br /> '99 J f U2 e o!/G�-S b � l� � vv� v�ov <br /> 6. Add�'�/ON �OQ�C( `/10� /�7C/7�t�er �I a y yN Q 'T <br /> ' �� /✓f �� : N oS3 <br /> / 1 in <br /> D C7. i r�a�tl !n(gs1 'cn m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of G3knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ' o.all information contained in this application(including any accompanying schedule)and I further declare that I recogn : m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to 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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other CU i m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. m <br /> m : <br /> SIGN HERE <br /> (J-lh-rte/' '/' <br /> (signature of owner or building contr c ) (date) <br /> ZONING ADMINISTRATOR <br /> iA fA fA fR to H� <br /> N N N N N N N <br /> N N O ut V1 0 0 <br /> TOWNSHIP PERMIT MAY BE REQUIRED 0 0 0 0 0 0 0 <br />