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BuYnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> OWNER (,L TELEPHONE <br /> l�riv,v T N 1� N 0 = o <br /> /, �j�jQ � <br /> HOME ADDRESS ; 2/>U (0 #1 S,06 At R 1,Aj [e S /C �'t 0 <br /> 0 <br /> r m <br /> p 0 <br /> EMERGENCY/FIRE NUMBER G)'3 p v ROAD NAME W14 fS 19t'-7,,f 1" P,vr,.F p, <br /> C 1 0 -7ASkZ114'r 6'bR'IsW- 2%qo-ITo! _(r 09360 LoTZ 4:1 V Z J <br /> LEGAL DESCRIPTION (see tax receipt) 11 u T t m <br /> 39 CIA,, 6;y t0 &/ -SEC 1 Na Cl)SL 5 Le z 1 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE M ADDITION ❑ PRIVY ❑ r^� <br /> TYPE OF PERMIT(S): V'c _? <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ C5. <br /> STRUCTURE/ADDITION USE: t5 Tb 2 4 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) Cl) <br /> m <br /> BUILDING CONTRACTOR: CD <br /> v <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 /> y O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> �t a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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. 1 a <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N 1 <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. 40 <br /> o <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. Cr <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> 0 <br /> CONDITIONS OF PERMIT: <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. 0 <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. m 0 r.-�, v v <br /> CD <br /> g nn <br /> 3 cL cD L1 <br /> '0 N C N y o7. 3 <br /> COD q <br /> o <br /> lN : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ti G)c p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m C <br /> CL all information contained in this application(including any accompanying schedule)and I further declare that I recognize m O <br /> m <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 chr a irtiste ' county ordinances or other m <br /> authorized person to have access to the above described premises y na s of inspection. r {� <br /> C% <br /> iCj <br /> SIGN HERE d CS tL O <br /> (signature of owne r b ding contractor) 9 1 7 •�ntli ) Q <br /> LY:2 <br /> ri G{Jl/t E17: <br /> ZONING ADMINISTRATOR <br /> t»f»f»wfn <br /> Coy NTN PN9NNfn <br /> ll�V 0 (n to 0 <br /> TOWNSH PERMITS MAY BE REQUi QUING q00000 <br /> 00000 <br />