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Burnet <br /> _tCounty 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator U c o <br /> APPLICATION FOR LAND USE PERMITS - <br /> OWNER ��� l S �� K� )/Z✓r �-' TELEPHONEn W <br /> fS.J v � � <br /> 2 0� fJ �� r�11 ,f SAL ° � <br /> MAILING ADDRESS C A <br /> � / � <br /> PROPERTY ADDRESS <br /> t <br /> LEGAL DESCRIPTION(see tax receipt) S 2-00 f ` \ 1 t t S u-J KW(\ 4A *T > d CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION TT 0 <br /> TYPE OF PERMIT(S): ` Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 1 t a <br /> STRUCTURE/ADDITION USE: rH� 12 <br /> � IBJ 7 Fl LI'-� q E G 'TK 36 0 ` <br /> (Home Cabin;Commercial Business; Bedr m; Deck; etc.) cn <br /> ""�� w <br /> BUILDING CONTRACTOR: i r,� L 0 d <br /> r , iA of -0 -I <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 2 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T - ('u1 <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a --Z <br /> 7! z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. A m jo <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. `' c <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 /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. hl <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 /> 1� o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFI¢� r(P1�1 NE WHEN y <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. �S �✓ ` o <br /> CONDITIONS OF PERMIT: Ale <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF P <br /> ISSUANCE.2. <br /> 3. NO GRADL OR ING OR SHING OF TREES AND ORELAND ALTERATIONS AREI ALILOWED UNLESS SPECIFICALIS RESTRICTED ALONG LY LIN�ON//V��JN <br /> PERMITTED. ^� <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER Q <br /> SETBACK AREA. �I <br /> 5. <br /> CD W 05 00 Cal M <br /> m C y y o <br /> Z n 10D7. o c <br /> o "` ` m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m - ` D <br /> PP ( 9 Y ) Y Y G) C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m o �, <br /> La v, • ra <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m c o mm <br /> that`t(iis 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 1 am ID <br /> providing in thisappl tion. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized perso h e access to the above described premises at any reasonable time for the purpose of inspection. m m o <br /> SIGN HERE <br /> C <br /> signa�turee of owner or building contractor) a (date) a <br /> ZONING ADMINISTRATOR /��✓1 <br /> i <br /> _ICI Hi 0 FA fA N <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> �l RHIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />