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Bufnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator� o <br /> APPLICATION FOR LAND USE PERMITS <br /> r <br /> C.N O <br /> N <br /> OWNER C>►{`v J j �VN�C �!� TELEPHONE� -3 rat - 77 45 <br /> HOME ADDRESS IS I (* DR I N�7 f K ►Q`D S'R LL W AT ee r4'hJ S 5 o g z v W <br /> EMERGENCY/FIRE NUMBER 303- ROAD NAME 567LM N LEN RD <br /> l <br /> LEGAL DESCRIPTION(see tax receipt) Loo 5 C SM e V6L 1'1 t'n AgE' k q 6 � CD <br /> 0 <br /> DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY 5Q Cl) 0 <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5 <br /> / J � m <br /> STRUCTURE/ADDITION USE: C ��ti� _� DdGi' / W <br /> (Home/�Caebin; Commercial es� <br /> Busins su, <br /> edroom; Deck;etc.) <br /> BUILDING CONTRACTOR: �ON tJ N LSOIQ SELF) <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81AX 11 SHEET OF PAPER. ANY INCOMPLETE OR -n3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C1 m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). CO) <br /> \ 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)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. P <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. \ j <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N w <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 9j <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN ` Ct U <br /> NEEDED. 5J <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o d <br /> CONDITIONS OF PERMIT: y <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. v <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY !, <br /> PERMITTED. Q <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER 1�7 <br /> SETBACK AREA. <br /> 5. <br /> A n v v v <br /> CD 0 ' � m <br /> 6. mB CL� ic <br /> a : mC0114 rnN3 <br /> 7. Z ' '" mom : )o <br /> o <br /> y : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my (j 10 <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy ofCL <br /> c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ' M <br /> (� . m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- N 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 in this application. I agree to permit county officials charged with administering county ordinances or other to <br /> authorized perso ve access to the above described premises at any reasonable time for the purpose of inspection. T <br /> m : <br /> f° <br /> cn <br /> SIGN HERE <br /> (signature of own or building contract (date) l <br /> ZONING ADMINISTRATOR w� <br /> wwfnwt» <br /> N V 7 N N V 7 <br /> utO V7(T O OO <br /> TOW SHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 <br /> P <br /> �LL�u <br />