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Wenett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator CD 70o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 hY ` <br /> 41-fZ1#e-k4'1 OWNER � `, TELEPHONE 6S'/-y 3D-laSy <br /> CD <br /> HOME ADDRESS /0'7 i7 /v y fi Al SPI( (i.-/ 411e4 /4H, SL5'od'Z o� <br /> ` m <br /> EMERGENCY/FIRE NUMBER U 86 7 ROAD NAME i!5 &L401 /k, yew" <br /> 41y11s'n 2 - Sa /"1'34 1 yAa ACAta 1, 10p <br /> LEGAL DESCRIPTION (see tax receipt),A-st-fy'a3-C o3710 "4/ CSM v 7 P%9S4 Ike< Cn <br /> m <br /> best. ✓ 9'/I7 PSroZ ,N c <br /> 4&v, dt Z <br /> T <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ ° <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING ❑ CAMPING UN L❑ SUBDIVISIIOON ❑ < <br /> STRUCTURE/ADDITION USE: CA�r NG/e �.►G t ! 0 <br /> Home/Cabin; Commercial Business; Bedroom; Deck; etc.) U <br /> BUILDING CONTRACTOR: Al AADA-0I4 ^ RAAaj J"-5 e—'M'^ 51 A&, <br /> ' 1 � <br /> CD l� <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p y 1J n <br /> �1 m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) o. <br /> O m <br /> T O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> Co <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 ` Z <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. O <br /> 5. 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. '° ° <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. o <br /> 4. NO TRUCTRUERES, INCLUDING RETAINING WALLS, ETC. ALLOWED WITHIN THE REQUIRED WATER <br /> SE ACK <br /> 5. L/I <br /> ;09W DOD : m <br /> . �� v o"� � <br /> 0n � <br /> "O (D C y N <br /> 6 3 <br /> Z N ° ° —I <br /> 7. T� m <br /> = rn : A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G> c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o 2 A <br /> all information contained in this application(including an accompanyingschedule)and I further declare that I recognize ° <br /> pP ( 9 Y 9 : � p <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 (� ° <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized perso to have access to the ilbove described premises at any reasonable time for the purpose of inspection. m m <br /> Q� m <br /> SIGN HERE Q"w Z �T Z / <br /> (signature of owndr or M' (date) <br /> ZONING ADMINISTRATOR e _ 0� �' <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />