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Burnett runty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o�C o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> to O <br /> N <br /> / / C <br /> CD <br /> OWNER � ��' t/-�A)G y TELEPHONE <br /> / o J� <br /> �f� ��}I.� I II <br /> HOME ADDRESS Q�99 �j9 � , <br /> r � <br /> EMERGENCY/FIRE NUMBER /e��' ROAD NAME,tI�C� EKE ,QD 1 <br /> L <br /> LEGAL DESCRIPTION(see tax receipt) �Z o�S'4I OF�� /� G� Ah�J �i f 1 CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY El C0- <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISIONc <br /> STRUCTURE/ADDITION USE: Snae.4G 11O//-SD/ aje, _, "� r <br /> 0 <br /> � (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) m <br /> / ^� <br /> BUILDING CONTRACTOR:-Pzf�S C�RRf�� CD <br /> �S� c�QQ�TSBd�G G(J�SL� <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> T 1 1 I <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. W <br /> � m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T o <br /> -n o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). N <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <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. <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 /> S. 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. 0 <br /> o � <br /> NOTE'. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q <br /> NEEDED. �» <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 9j <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. � 3cm % <br /> COD C: 0 <br /> 7. o N �� m � <br /> y ; <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my L7 c 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 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- m l7 <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other CD <br /> 0 : <br /> authorized person to have access toa above described premises at any reasonable time for the purpose of inspection. m <br /> M : <br /> CD : <br /> 167 <br /> SIGN HERE <br /> (signatur of ow r or building contractor) (date) <br /> ZONING ADMINISTRATOR . . . <br /> �A6940ift4� <br /> N ra01 N N0101 <br /> 01 01 0 01 01 0 0 <br /> 0 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 0000000 <br />