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uhr <br /> Burnett Bounty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 0Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N � <br /> N <br /> C <br /> OWNER C ogd }m C(je lai y TELEPHONE o <br /> HOME ADDRESS VC(h C{LIF Lc � C�iLG� A, S3'o C��� 0— <br /> EMERGENCY/FIRE NUMBER a O �� 1— ROAD NAMd� 1G0 t-,' q.vC�? IPCJ (��1~ <br /> EGAL DESCRIPTION(see tax receipt) rn <br /> rn <br /> 0 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE � ADDITION ❑ PRIVY ❑ � � <br /> TYPE OF PERMIT(S): <br /> cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> /' cr <br /> �� 7u / 5 <br /> STRUCTURE/ADDITION USE: S I tU 0 GJI[ / <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: CD <br /> lit <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. In <br /> O <br /> N O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T o. <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C1 obi �p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m I <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO rn 3 <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. 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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. (J <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. m Fo <br /> O 9 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED. Cr <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z [n <br /> CONDITIONS OF PERMIT: orZ <br /> ) <br /> d <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. N, <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 /> 3 <br /> s. a m <br /> . o <br /> 7. Z : y %� <br /> o : <br /> =0) s m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Zj c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m m <br /> that this information 1 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 rel in om1fciii, <br /> m m' <br /> providing in this application. I agree to permit county officials charged with aer m <br /> authorized person to have ccess to the above described premises at any reaso r r ,I E E <br /> (DS <br /> SIGN HERE <br /> (signal of owner or building tractor) Ay <br /> 4J <br /> ZONING ADMINISTRATOR —:Zlm C <br /> � <br /> ZONING NM <br /> N u N N ou,v, <br /> � oPPo <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 <br /> 0000 0 0 0 0 <br />