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Burnett Cbunty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N w <br /> `, ` � j C <br /> OWNER P V ` +{�4 ry� S TELEPHONE ` 5 3-19 5 701 <br /> HOME ADDRESS �{� ),.(S W Dort' l.t� .Qo�d .?� 1�V 016tCD <br /> EMERGENCY/FIRE NUMBER �P�.4 rn q V Q r�- ROAD NAME �r A(tD Q A rn R42. J <br /> �j <br /> LEGAL DESCRIPTION (see tax receipt) <br /> (} O _ <br /> o <br /> DWELLING/BUILDING I GARAGE/A CESS RY STRU 0 E ADDITION ❑ PRIVY <br /> TYPE OF PERMIT(S): tr <br /> a <br /> FILLING/GRADING F-1 CAMPING <br /> /UNIT` ❑ SUBDIVISION ❑ S. <br /> C0 <br /> STRUCTURE/ADDITION USE: RU RIC `� l�Q D 1 e� �h oP <br /> 0 <br /> (Home/Cabin; ComImercial Business, Bed`rm; Deck;etc.) (moo m <br /> BUILDING CONTRACTOR: ��'IC�rSa� LO�, G <br /> CDv <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> .-O N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o �1 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. t7 o0i <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m :° <br /> NORTH(N). y <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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. P <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. 1 <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 3 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 1 o <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN W R � <br /> NEEDED. �j <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> ` 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 0'L, <br /> ISSUANCE. I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ®I1 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER Q I� <br /> SETBACK AREA.^' Q ,����7 ' j� <br /> 5. �liyl h LQ�I C l 4�& ld'.' Ll — �t� J (� J�� /l'ItJ <br /> 6. Pla.�. 'Y (/ U m � 3 n m x Q=La a� <br /> mC= Ho53 <br /> 7. o N M 0 <br /> — m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my i7 arn .'i i iC <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of L' <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize C m <br /> M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- t7 <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 applicatiork 1 agree to permit county officials charged with administering county ordinances or other �; m <br /> authorized person to have a ess to the above described premises at any reasonable time for the purpose of inspection. m <br /> CD <br /> m : <br /> SIGN HERE <br /> (signature of or building contractor) (date) r <br /> ZONING ADMINISTRATOR ry� <br /> wtowww. <br /> N N f T N N N <br /> -to <br /> fT f110 V7 Cn 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 <br />