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B4rnett County 7410 Co. Rd. K,No. 102,Siren,WI 54872 Office of Zoning Administrator W o 0 <br /> APPLICATION FOR LAND USE PERMITS - <br /> r <br /> a o0 <br /> OWNER ��� Q` �,s� TELEPHONE 0 ! ,V m K <br /> m <br /> MAILING ADDRESSCD <br /> r <br /> p. ` � 7 0 <br /> PROPERTY ADDRESS <br /> ���� r <br /> LEGAL DESCRIPTION(see tax receipt) s�{`U/� /a 7wp /V ,(of Q am V 13 P ao 7 t `� <br /> t� o. <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION � Cs 0 V ri toO <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION F-1DCG •n <br /> 7�ecN <br /> STRUCTURE/ADDITIONOSE: K 8`VaVl-1 � <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) U �. <br /> BUILDING CONTRACTOR: !Y JR&I-e <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR In 4� <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> O �, O <br /> N C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a \� <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF p Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. f�J ° <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. ry <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. 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITElV 0 HEN <br /> NEEDED. lr rrrr���u IIII�L J �� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 0 -�j <br /> JUN <br /> CONDITIONS OF PERMIT: 4 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS M � y✓ <br /> ISSUANCE. C'QV - -L <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORE�jN NTY <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY �i <br /> PERMITTED. e,'• '' ^� <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER W <br /> qET�BACK EA. � / _ <br /> 5. ( v // � (� Vy/ <br /> vl 0 mmc�i0>aFm <br /> 6. CD B CL CD x <br /> � mCy �' o9 <br /> Z rA � o Oros <br /> 7. o -n� <br /> 1 declare that this application (including an accompanyingschedule has been examined b me and to the best of my <br /> r^ <br /> PP (� 9 Y ) Y <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of C E Fn f <br /> n - : cn <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m e <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 Burnett relying on this information I am ro E <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to ave access to the above described premises at any reasonable time for the purpose of inspection. m i <br /> - o <br /> CD <br /> / h � E m , <br /> SIGN HERE �C d' <br /> cqata <br /> or bullctor)sig >60 of ding (date) n '• <br /> ZONING ADMINISTRATOR M � i <br /> N <br /> 0 W 0 0 <br /> TOWNSHIP PERMITS MAYBE REQUIRED �37 �W <br /> �1�TH1S PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />