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Burnett t aunty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrate -V o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N 0 <br /> OWNER a r e S r ,Tdz/rT G� TELEPHONE <br /> " <br /> m l <br /> HOMEADDRESS r <br /> EMERGENCY/FIRE NUMBER ROAD NAMEOr- <br /> �a <br /> LEGAL DESCRIPTION(see tax rece 5 7-0(04-' 41 <br /> s T 3 C S.N [/ 1:3 P ayr1- Co J ��TS 3 v m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTU REX ADDITION ❑ PRIW ❑ of <br /> 0 <br /> TYPE OF PERMIT(S): c - <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ S. <br /> S. <br /> N, <br /> STRUCTURE/ADDITION USE: �' �e� %D'f/ Ro°.w - l:1 , P <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) a N J <br /> BUILDING CONTRACTOR: <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'h X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) <br /> 3- 3- <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. � 'A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m c <br /> NORTH(N). UU}} <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. <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 (� <br /> MUST BE SIGNED AND DATED BY THE OWNER. �Y o `(I� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN W <br /> NEEDED. �^ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. PZ ` J <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. ) <br /> 3. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RE <br /> X� l� <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER � <br /> SETBACK AREA. �J <br /> s. X � 0 Q m <br /> CL <br /> 6. m co 9' 3 <br /> 7. <br /> O fA <br /> N O ti] <br /> _m: Im <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G3 C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofo Er <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ��; '^ m m <br /> that this 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 I am .": : <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> m : <br /> SIGN HERE —T <br /> sign ,of o er Ildin ntractor) (date) <br /> ZONING ADMINISTRATOR fn v+w fn cn fn <br /> N N (JtN (Ji <br /> N <br /> 0 U Opt W OO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0000000 <br />