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Bonett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> 0 l�1 <br /> rn � �I.J <br /> OWNER �FQ IIAJ TELEPHONE - S�Q� (� <br /> HOME ADDRESS sl�® O.TjtO/g �LV)). /W,7-,� <br /> 5 s-y�9 0 <br /> EMERGENCY/FIRE NUMBER 4�2-7 (0 ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) f D �-L J \ 9 <br /> s s` �/ D-/s <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ <br /> TYPE OF PERMIT(S): Qb v ' <br /> FILLING/GRADIN//G,,❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: /�6/iR C/C � 0 0 <br /> (Ffome/Cabin; Commercial Business; Bedroom; Deck;etc.) m �J <br /> ,tom <br /> BUILDING CONTRACTOR: � UlCD <br /> (� <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/x X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> :O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) In CL <br /> n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). W o <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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. �J I 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. `Nn <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. -11 N pper`� <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR,ETC.,THE PLANS 0 Jl l <br /> MUST BE SIGNED AND DATED BY THE OWNER. m $o <br /> O 9 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z � <br /> CONDITIONS OF PERMIT: P L I <br /> ( <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT r' , <br /> ISSUANCE. Y✓ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <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 AREA. <br /> 5' Ic QOuj or'.' S-1je <br /> _ <br /> Git ulth � ✓�o li m ° <br /> O <br /> 6. /VC) G/ ? a�� - M6Uv <br /> 7. o y ZIJ : <br /> _m m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my g C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <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- 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 m <br /> providing in this a plication. I agree to permit county officials charged with administering county ordinances or othero <br /> CD <br /> authorized perso have access to the above desc 'bed premises at any reasonable time for the purpose of inspection. m <br /> a : <br /> a <br /> SIGN HERE — OR CI (i1Jrll�,/lA —,3 / O <br /> ��(shatu a of c6mfer or bu n ontractor) (date) <br /> ZONING ADMINISTRATOR � � w <br /> wf <br /> " "MNN1 <br /> N fT (nut <br /> V10000000000(TO(T M000 00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />