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Burnet County 7410 Co. Rd. K, No. 102, Siren,WI 54872 <br /> APPLICATION FOR LAND USE PERMITS Office ofning Administrator 3 o 0 <br /> 0 <br /> y O <br /> OWNER Q A9 VA) TELEPHONE <br /> HOME ADDRESS Nn3 /�-VA)T,Y �/� / v s � <br /> �.v /T O <br /> EMERGENCY/FIRE NUMBER OZ 3.�S( ROAD NAME a,*L;A1ry 40 1 <br /> CD <br /> 2 <br /> IMPORTANT: Be sure this description covers your prot»rry.TMs <br /> LEGAL DESCRIPTION (see tax receiF o!Tr1,0T tyl }Iyp apa may not be a wg Npat de <br /> /T -?.'d;Rt4W ACT?ES <br /> r(I Ba r,. gt . <br /> 1:1Q DWELLING/BU 02¢00 TYPE OF PERMIT(S): VPRIVY ❑ o(- OT f, <br /> FILLING/GRAL.._ wovrv101UN U n <br /> STRUCTURE/ADDITION USE: 44Ks- 4jMk T. <br /> 0 <br /> (Home/Cabin, Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: RIP A/ A(rY�U`r��y J �/.t/LhKtTiFD � <br /> w <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8Y:X 11 SHEET OF PAPER. ANY INCOMPLETE OR v <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. B <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING, (AERIAL OR TOP VIEW) <br /> O m <br /> -n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF '�-o <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO o <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. O <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN o <br /> NEEDED. � p , <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ti <br /> CONDITIONS OF PERMIT: O I i <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 1 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK <br /> (�!✓�- <br /> 5. <br /> X 'a 0r- D0D0M <br /> 6. m mo m a f m <br /> COD `< 3 a m x n ;a <br /> 7. N C N N O S <br /> Z N N O : O f0 <br /> I declO ;aT`�are that this application (including any accompanying schedule) has been examined by me and to the best of my A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of u c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- �' `D <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 L7 <br /> providing m <br /> a gin this application. I agr permit county officials charged with administering county ordinances or other m <br /> authorized person to have acce o_jk6 above descri-bgdpremises at any reasonable time for the purpose of inspection. m <br /> D <br /> m <br /> m : <br /> SIGN HERE <br /> (signature of ow' r r b da ) �: <br /> ZONING ADMINISTRATOR q <br /> d <br /> SLJ <br /> TO SHIP PERMITS MAY BE REQUIRED `� <br />