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BWrnett Dounty 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administ�rator - 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> CD <br /> OWNER <br /> TELEPHONE <br /> m <br /> HOME ADDRESS � 3a� CT�� C � i ��'3p v 0 <br /> r � <br /> 0 <br /> EMERGENCY/FIRE NUMBER ' /// ROAD NAME t <br /> LEGAL DESCRIPTION(see tax receipt)! 1 7/T YO /Q �lnitJ �TOJT. 3 <br /> DWELLING/BUILDING1:1 GARAGE/ACCESSORY STRUCTURE ❑ ADDITION PRIW ❑ C� c 0 <br /> TYPE OF PERMIT(S): <br /> o- <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ �et° ^ D c <br /> STRUCTURE/ADDITION USE: ,TcJ4EA1 &A&.S� S7l eAe,,C' JrllirM 'O / � � <br /> (Home/Cabin;Commercial Business; edroom; Deck;etc.) ro ^ <br /> BUILDING CONTRACTOR: Z2!2:GE AJ 72-P aCG7;1DAlCD <br /> � j\ <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. m r� <br /> :0 in , <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m Q <br /> n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 oOi 'p <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 /> 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. % � c <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 <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 o <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN '" <br /> NEEDED. n f <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. oC .� <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ( V <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG S E. I <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SP IF] J 1� 1 <br /> PERMITTED. ! u <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN T EQUI 'r <br /> SETBACK AREA. <br /> s. PrL #V jAl bt- I tv SPrl�f ,. U���,'�, <br /> " Xvnr o ov <br /> rn = m �' �^ m <br /> s. orlV I Plaf— lug. pf.. ����g�8� C/q�� 8 a a L <br /> 'fl aCin m > > 3 <br /> 7. o f i = i 1 <br /> 2 C o : = rn m <br /> I declare that this application (including any accompanying schedule) has been examined b n of my `tom c p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail arfd accuracy of W d E S <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognizem ;a <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- O <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 Q 1 m <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 9 <br /> (sign re of wrier or build g c tractor) (date) <br /> ZONING ADMINISTRATOR &, <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />