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WWNb <br /> Burnett Count, 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N <br /> U <br /> C <br /> OWNER ��� �e�hk,� TELEPHONE 7G3-- 371— 32y1 <br /> .2-, <br /> m <br /> HOME ADDRESSAll <br /> o <br /> EMERGENCY/FIRE NUMBER 0177,? ( ROAD NAME 6'cr (n 1 r <br /> LEGAL DESCRIPTION (see tax receipt) e) 6 sem, p S L✓ 0) <br /> 1 CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION PRIVY rn <br /> TYPE OF PERMIT(S): Cr <br /> a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ g <br /> STRUCTURE/ADDITION USE: ZAAMWW'- r'`olStoG'4� 0 <br /> (Home/Cabfn; Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: -T-lee- A"Sk, 1 fii <br /> v Q <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 = \ <br /> M <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 ii <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. c m v O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y G <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 Ql v <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. I \. P <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 Q . <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 X l <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Cr P. <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o r <br /> CONDITIONS OF PERMIT: <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 V <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER Q, <br /> SETBACK AREA. <br /> 5. <br /> This structure to be used as private residential v v o v <br /> 6. garage/storage only. Not to be used for human 3 a H f_ �m <br /> a m Ctn ON <br /> 7 habitation. o (R 'Co <br /> M <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my i3 C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> sue a permit. I further accept all liability which may be a result of the County,of.Pturnett relying on this information I am d <br /> providing in this application. I agree to mit cqWftj of' Is charged with iking county ordinances or other m <br /> authorized person to have access to o e premises at any reasons e"o-for the purpose of inspection. CD <br /> m <br /> m : <br /> °C /SIGN HERE �d OD . <br /> (signature f owner or building contractor) ! 0 (date) <br /> ZONING ADMINISTRATORM Ln <br /> �I ' v+ <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 0 0 <br />