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BuCnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator ' o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> - r <br /> el T <br /> OWNER y�'� Y n <br /> Il U55 ELL G G TELEPHONE �Jz- g90 //y' 2 <br /> m <br /> � /J'//A C N M <br /> HOME ADDRESS �3"JPO f/�p��y ��, �!/��S u/L 42t A J"s �i 7 9 <br /> EMERGENCY/FIRE NUMBER .4-'9 r/p4� ROAD NAME �iti�G�Sk <br /> II_ <br /> LEGAL DESCRIPTION (see tax receipt) p 4:::5 �0�7 LOT S� c <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ® PRIVY ❑ ( fn <br /> TYPE OF PERMIT(S): a <br /> Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUB ION ❑ <br /> n <br /> STRUCTURE/ADDITION USE: [�EDr�ooA47 A,,/cr pw, a' <br /> (Home/Cabin; Commercial Business, Bedroom; Deck; etc.) y <br /> BUILDING CONTRACTOR: 'F�✓Ss�LCJ <br /> G��EG <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. 0 W <br /> x a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. t7 m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m fD <br /> NORTH(N). S 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m d <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. ( 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. I N d <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 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q <br /> NEEDED. 0 9i <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z a <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Ca <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 n <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. 5Creel\j �'"t \ 1✓ <br /> I / 1t�/w m v_ <br /> mp <br /> o ov= n <br /> 6. 9m C y w o 9' 3 <br /> 7. G ie <br /> =rn m <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my c ID <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize <br /> : m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- v <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 m <br /> authorized person to have access to the abov#described premises at any reasonable time for the purpose of inspection. m <br /> M : <br /> nn M : <br /> SIGN HERE 7' 06'y <br /> ( natu of owner Id' contractor) (date) <br /> ZONING ADMINISTRATOR <br /> cn to to t»ri M Ln <br /> N N V1 NNfly0 <br /> fT Ut O 01 01 O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />