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0l&3Wtf' <br /> I3urnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 'a c) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> VT 0 <br /> A aSki <br /> OWNER A-R - L i N b TELEPHONE '?52--690--13ti3 o <br /> HOME ADDRESS ` I L . L � <br /> 1 3 `1 /� e M la to IR IJ S V ► 1 G 1� S�3 3 7 0 <br /> � T <br /> EMERGENCY/FIRE NUMBER 1q S T G ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt)Lot <br /> T <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE X1 ADDITION ❑ PRIVY ❑ 0 <br /> TYPE OF PERMIT(S): c <br /> FILLING/GR/AD�I�NG CAMPING UNIT El SUBDIVISION ❑ <br /> a <br /> STRUCTURE/ADDITION USE: GAk- G-6 X (Z D — o ( /p <br /> v 1 <br /> (Home/Cabin; Commercial Business; Bedroo , Dec ; etc.) N <br /> m _ <br /> BUILDING CONTRACTOR: 5 L L- FCD <br /> v ) <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n – <br /> O O <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> In n <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. a <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 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OFCZ 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. 0 <br /> 0. <br /> � F <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN S <br /> NEEDED. Q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF ERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SH <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFI C� <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN T EQUIRED V <br /> 5. $ETBAC��EA <br /> This structure to be used as private residential �(� `� C 0 0 CI M a e M <br /> f m <br /> 6. garage/storage onl q/�/r^� m 3 a 2 0, 2. ;a <br /> y. Not to be used for human m c N N o ; 3 <br /> habitation. C a o <br /> �. ZON/N OUN�, n� m <br /> �j = a': A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of 2 m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> CD <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 topermit county officials charged with administering county ordinances or other <br /> authorized person to have a cess to the abo described premises at any reasonable time for the purpose of inspection. fD <br /> -n <br /> CD <br /> m <br /> SIGN HERE <br /> (signature o er or building con for (date) <br /> ZONING ADMINISTRATOR M <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />