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eurnett Cov qty 7410 Co. Rd. K, No. 102, Siren,WI 64872 Office of Zoningii is or - 0 0 <br /> co APPLICATION FOR LAND USE PERMITS 3 <br /> N Ow <br /> c <br /> FL <br /> OWNER �NC3\jec� TELEPHONE <br /> nom_ \`c� `2_ , <br /> d � <br /> HOME ADDRESS WO' M0-�A+0AA0di + SSI It v r <br /> CDo <br /> EMERGENCY/FIRE NUMBER x' fed f r ROAD NAME "CNr V-%h <br /> 1IOU io}Z t 52-2-• S, T 3`d N 1 ► 5 LD <br /> LEGAL DESCRIPTION(see tax receipt) 3 Z-99 I q 1 I -I <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE 66 ADDITION ❑ PRIVY ❑ N o <br /> TYPE OF PERMIT(S): r <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> 5. <br /> C !_ m <br /> STRUCTURE/ADDITION USE: � <br /> ;4Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: RoePr-j �)Ck,n�ekD' <br /> v <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. p W ( -[ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 0 <br /> 1SO Z <br /> . ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 5m <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 <br /> CENTERLINE OF ROAD,(C)BUILDINGS)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF V� o <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 /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. r�C <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. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN ea ° �J <br /> NEEDED. (�1 <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. w <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. G <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. f� �( <br /> 5. / 2 Oh 2 ��1SiGf �o $ Sf/�/Gff� Dl' <br /> .00 <br /> r- C <br /> O <br /> s. Q ✓ C�r1 / cr' ,'�i'e s, 7Y�S 6 �`f- C y o 3 <br /> 7. o <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of n <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognize (% m m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- VL v <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. <br /> m <br /> SIGN HERE <br /> `! T <br /> (signatu f own r b i ctor) (date) <br /> ZONING ADMINISTRATOR <br /> fn41014He.�10 <br /> N N(7� NN (nN <br /> ()1 (T O t71 fJl O O <br /> T WNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />