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Barnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator vci Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r l� <br /> /A <br /> OWNER T�►.VL �S I I z &S r� TELEPHONE 6��- a.� C p,?O-Z 0 W_ <br /> HOME ADDRESS 1,;;z6 ® / ,�i¢rty I�O�/✓T, �t,rnsut' e- <br /> r <br /> EMERGENCY/FIRE NUMBER Qq 375-- ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION PRIVY ❑ Vf c <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ c <br /> 5. <br /> N <br /> STRUCTURE/ADDITION USE: L/ip� ��rger e, 0 <br /> (Home/Cabin; Comme cial Business; Bedroom; Deck;etc.) rn <br /> BUILDING CONTRACTOR: <br /> 1 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/a X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> MN c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n n <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m �? <br /> NORTH(N). <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m a <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. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> Ct ^ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN0 <br /> Ct `v <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> 0 <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. pI <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. This structure to be used as private M -U 0 r o o <br /> 6. residential garage/storage only. Not to be 0 a m N a- 3 <br /> * CS . <br /> 7 used for human habitation. 2 :; y <br /> o : <br /> rn : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my t3 c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m C <br /> CL <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize \ CD <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- p <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am m <br /> providing in this application. I agree to per unty officials charged with administering county ordinances or other m <br /> authorized person to have access to the ve dperibed pre sonable time for the purpose of inspection. m <br /> CD <br /> m <br /> SIGN HERE � <br /> (Sig <br /> iiaturl o g ((date) <br /> ZONING ADMINISTRATOR L _ 00 <br /> 49 <br /> �41)'Af <br /> N N ut N N N <br /> Cn U1 O Cn N O <br /> OWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 <br />