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orn 66yv <br /> Buanett CSunty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -a OZ <br /> APPLICATION FOR LAND USE PERMITS 3 ° <br /> y 0 o <br /> h � c <br /> OWNER r7 /1 /r C� TELEPHONE 7 <br /> HOME ADDRESS / �� OO �r` S7 . f �yr703 R 0 <br /> 4-CX live Jahn��->••„-.�W��., ,. ,__ e <br /> EMERGENCY/FIRE NUMBER ROAD NAME w <br /> 4/ <br /> LEGAL DESCRIPTION(see tax receipt) �Oy�iAy T /v_T./ /2l ) row;l f./ . y <br /> �r ( / �Y 4 �o y e <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ y o <br /> TYPE OF PERMIT(S): C/ 0 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> 41 <br /> STRUCTURE/ADDITION USE:_ r .,eJ <br /> ( ome/Cabin, Commercial Business; Bedroom; Deck;etc.) y ' <br /> BUILDING CONTRACTOR: ]C �N /►� { /1 D.+ <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR R <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. C -n 3 <br /> dAJ � m <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) <br /> i 5CIL <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 9 <br /> NORTH(N). C O <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. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO rp <br /> BUILDINGS,ROADS,LAKE,LOT LINES. d <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <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. S c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN 0 <br /> NEEDED. q <br /> n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o <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 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. + <br /> 6. m 3 K � m <br /> L <br /> N N = 3 <br /> D C7. <br /> y O O <br /> XI <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ZS Cn m <br /> c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize C 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- G� <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett rSelryipg on this information I am <br /> providing in this application. I agree to permit county officials charged w' 6¢tater, <br /> "'sl LMty ordinances or other tH e , <br /> authorized person have access to the above described premises ata i= ,Qnj15r, lr e t rpose of Inspection. <br /> m E <br /> CD <br /> SIGN HERE l � �� to <br /> ,At E <br /> (sig tur o owner orbuildin co actor) �I 'F (date) <br /> ZONING ADMINISTRATOR I W <br /> wwtn v+tn fn r' <br /> R�/CCI,ijUN 1VG (n P O V1 OI O O <br /> TOWNSHIP PERMITS MAY BE REQUI b o 0 0 0 0 0 <br /> 0000000 <br />