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�?�t coYy� <br /> Bl�rnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v O Z <br /> APPLICATION FOR LAND USE PERMITS 3 ° <br /> r <br /> r� <br /> y0 <br /> OWNER SCi2�4 Y c �1 IC �(1 I TELEPHONE !c ( — . <br /> t{ `v�� _ 1�9 � <br /> v <br /> m <br /> HOME ADDRESS Icy W, I'1'1 Ck,%LVjC 1 St. 1 1'1'1 N.) !s7--- I '7 O <br /> !r m <br /> EMERGENCY/FIRE NUMBER 5 -2 ROAD NAME �C�t✓i�ti �� /vh <br /> �'1 0) <br /> LEGAL DESCRIPTION(see tax receipt) ��' (, � � i � � �� _ (� I y <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY c STRUCTURE ® A e <br /> TYPE OF PERMIT(S): o <br /> Or <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION c; <br /> N <br /> STRUCTURE/ADDITION USE: ��C{'G.V.,, ? , /� J oN'�" <br /> (Home/Cabin; Commercial usine ; Bedroom;D ck;etc.) y <br /> II^ ( m ^ , <br /> BUILDING CONTRACTOR: fir <br /> ✓IB(l7SIckEi ` '�lO <br /> v <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. O <br /> x N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T Z <br /> 2. 4 <br /> SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 9 <br /> NORTH(N). r- <br /> 3. <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO • m I <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF v\I <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Zc <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. ( N C,j <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR,ETC.,THE PLANS S <br /> MUST BE SIGNED AND DATED BY THE OWNER. o I <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> 0 <br /> NEEDED. Cr2 p <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z \' <br /> CONDITIONS OF PERMIT: P <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. 1 <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 /> s. = dam 0m <br /> mo <br /> �� 3a 0 <br /> (1 =- : : m <br /> I declare that this application (Including any irccompanying schedule) has been examined by Ore and to the best of my O <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofm : c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize : C m : x <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- L7 p <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 pp g P ri <br /> p g in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to a acces a above described premises at any reasonable time for the purpose of inspection. <br /> rn <br /> SIGN HERE <br /> (si natureown r or building contract ' (date) <br /> ZONING ADMINISTRATOR / <br /> to fn to cnwtx40 <br /> , N Nf11NNfJ1 Vt <br /> ut Gig O ut 611 O O <br /> TOW SHIP PERMITS MAY BE REQUIRED a o 0 0 0 0 0 0 <br />