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Burnett Cr)unty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Adit risfr�ftiro 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> i <br /> N <br /> _ C <br /> OWNER <br /> TELEPHONE,/s <br /> HOMEADDRESSeY23sG QST CallNe25 Lk RQl 9Je/9CFeag A) <br /> R <br /> ROAD NAM <br /> EMERGENCY/FIRE NUMBER <br /> sT <br /> _ Sa�3s(o ( 'O , && �X IQQI. <br /> LEGAL DESCRIPTION (see tax ceipft) —� ~Ya q• /6 � S 1 <br /> ✓fi t- G of Town/ Rot eX EN btoCD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORYSTRUCTURE, ADDITION El PRIVY 1:1 CD 0 <br /> TYPE OF PERMIT(S): O c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: PbL e o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) y <br /> BUILDING CONTRACTOR: M Ak K 414.f1 Sage i c/ <br /> 1 <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/s X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> T 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 /> NORTH(N). C <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. N V' <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 /> � Q <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHENa 0 <br /> NEEDED. 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. l O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Ivf/4 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> �j�1T��/BACK AREA. <br /> `C_'4C-12C� <br /> A C) rn <br /> 0 0 rn <br /> 6. C:0 <br /> M 3 <br /> o <br /> - <br /> C: <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my (j c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of i m i c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize i m m ;a <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 m' <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person t ave access to the ajapve described premises at any reasonable time for the purpose of inspection. -n <br /> m : <br /> SIGN HERE <br /> (signatut of owlet or building contrac / (date) <br /> ZONING ADMINISTRATOR L J �r , E i 44 <br /> 69 'W "4N Nu1N N) 00 <br /> V7 V7ON f7� OO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />