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Barnett County 7410 Co. Rd. K, No. 102, Siren,W154872 Office of Zoning Administrator v a z <br /> APPLICATION FOR LAND USE PERMITS 3 4 <br /> �_ r <br /> N 0 <br /> OWNER I ma U 7RAPr aVI d TELEPHONb � 0 <br /> �7 / �J [jam_ At U I m <br /> HOME ADDRESS 0 615 l7bwek CT, � oyefL �-"goye- & MA �-�4 :2,:L <br /> T'�� �o <br /> EMERGENCY/FIRE NUMBER D6Q f ROAD NAME ShORe N`11C. (� <br /> z e+a! of GS�L/K o f g Ass 6-+te ee5 j/a �w <br /> LEGAL DESCRIPTION(see tax receipt) 6 JeL,d ry1e,,r7t LoT N N See f7JA/ �T <br /> 3^ D — C <br /> e <br /> DWELLING/BUILDING 11 GARAGE/ACCESSORY STRUCTURE V ADDITION ❑ PRIVY ❑ Vl 0 <br /> TYPE OF PERMIT(S): ii <br /> FILLING/GRADING ❑ CAMP UNIT �BtDIVISION /❑^ l a <br /> STRUCTURE/ADDITION USE: /X 3� T OI b1 pq `TAIL S-� j e' o' <br /> (Home/Cabin;( Commercial usiness; Bedroom;Deck;etc.) Cn <br /> /� <br /> BUILDING CONTRACTOR: D,4vlr (�iC7$�tt)4wi - 7�)VG 'Half-V - <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE , (l,_ 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. fP� lalSf`5 m <br /> O <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) S �S / �9 O m <br /> n cL <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 0 M <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). N 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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. <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. ,� c <br /> o � ( <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q <br /> NEEDED. n O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: G <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Q <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 1 1n� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY '[J <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. D <br /> mr� �< 10+ m ((D� <br /> 6. <Y G a nN yc Lk- x <br /> mcH . 0 � 3 <br /> 7. z : Hm , =j <br /> o <br /> y : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Zj c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ioI,CLS <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 1 m . <br /> that this information I 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 relying on this information I am d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other CD <br /> to <br /> authorized persona access to the above described premises at any reasonable time for the purpose of Inspection. m E <br /> m : <br /> _ m <br /> SIGN HE <br /> (sl to of owner o ding contractor) (date) <br /> ZONING ADMINISTRATOR • '• d, <br /> � 4, <br /> N N N UN <br /> (J (T N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 0 0 <br />