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Burnettq:ounty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> 7 )&yjjeJ 2d-M/ y = SU <br /> byrRS L 1 Cf ki y <br /> / a <br /> OWNER TELEPHON2- <br /> ) / f� ono+ <br /> HOME ADDRESS (0 a— 2e) <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) /O- " <br /> /� a 70 ( C <br /> N <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE4 ADDITION ❑ PRIVY ❑ <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a ` 'h" <br /> STRUCTURE/ADDITION USE: <br /> LJ!4 r0. S-e o Q <br /> (Home/ abin; Commercial Business; Bedroom; Deck; etc.) Cl) <br /> m <br /> BUILDING CONTRACTOR: '- <br /> m <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. r <br /> O <br /> ,Z1 y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <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 33 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF G <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 /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN o W <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� OF PE <br /> ISSUANCE. / (XJy I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED AL G SHIM. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY e:, ,o <br /> PERMITTED. Cf c �J VVVJJJ <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN TH�CD WAR <br /> SETBACK AREA. <br /> 5 /'Via NTy MMor- > 0 > 0M <br /> 6. < 3f m <br /> -o CDCy `" o � 3 <br /> 7. Z : ymo `nom <br /> o 21 m <br /> — � <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my A <br /> 2 C <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of o <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> CD O <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 <br /> providing in this application. I agree to permit co ty o ' ' s charged with administering county ordinances or other <br /> authorized person to have ccess to the above escri re ses any re nable time for the purpose of inspection. m <br /> m <br /> q_ Zo- �, <br /> SIGN HERE d <br /> (signatur f o rarj�pc r A (dat / <br /> ZONING ADMINISTRATOR "� G Z_ O( <br /> /U QIT <br /> A : <br /> T NSHIP PERMITS MAY BE REQUIRED 3 V Q <br />