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Burnett Count 7410 Co. Rd. K No. 102, Siren, vvL <br /> Y WI 54872 Office of Zoning Administrator Z <br /> APPLICATION FOR LAND USE PERMITS <br /> '/ /q <br /> Gsi- �yi- y�y3 <br /> OWNER /;,70- /q./10ry0W"C Z' er,..,a..TELEPHONE o <br /> '1 m_ <br /> HOME ADDRESS <br /> r m <br /> EMERGENCY/FIRE NUMBER 3/3 60 ROAD NAME Sf Roe' j <br /> LEGAL DESCRIPTION (see tax receipt) i ` <br /> ',of ✓o/ e?�Pg 2>a ,, S�-/Y NEXY st•c /L.7o si/ m <br /> DWELLING/BUILDING 11GARAGE/ACCESSORY STRU 'W ADDITI <br /> TYPE OF PERMIT(S): El PRIVY <br /> CTUREON ❑ N o' <br /> � � <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: /4QF) Cn C o <br /> (Home/Cabin, Commercial Business; Bedroom; Deck;etc.) <br /> W <br /> BUILDING CONTRACTOR: <br /> iu <br /> m , <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 WIL _ n 3. <br /> O w <br /> DIRECTIONS FOR PLOT PLAN DRAWING' (AERIAL OR TOP VIEW) = ro <br /> O a <br /> m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T z <br /> INDICATE <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND n o <br /> 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 Q✓ <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Q <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <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. <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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIN <br /> NEEDED. �J <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. d, <br /> CONDITIONS OF PERMIT: Nov , 9 Z <br /> 1r'!'r � ' 0 � 1 <br /> 1 <br /> ISSUANCE.MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF P&RNF7 , YUI <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE?ONIN®�Nn, <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY - <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK EA. <br /> 5. This structure to be used as private residential <br /> • N -V m r n 0 n O <br /> CO 6. garage/Stora ° f m <br /> habitation, ge only, Not to be used for human D a N N a <br /> C: <br /> 7. <br /> o in CD T o <br /> `< . .D <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ^1 A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuC <br /> racy of m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ti m 0 <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying to this information I am m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. CD <br /> �J <br /> CD <br /> SIGN HERE <br /> (signature owneror it r <br /> ZONING ADMINISTRATORat®� Q <br /> �j �7r✓ <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />