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Buinett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o z <br /> APPLICATION FOR LAND USE PERMITS <br /> i <br /> 3--�r-3.2/Z <br /> OWNER Ila a C {e 3 C /16 .l TELEPHONE 7/J/ [�_g - L��0 � <br /> ll--ll L /� �j <br /> HOME ADDRESS 3 J V C/ D 1 2 v ✓/ �� /t�/_f CD L(. . LIO� 7 tr7dl <br /> EMERGENCY/FIRE NUMBER ROAD NAM ,// <br /> C. +o v -o7q 3 <br /> Acres .�d)SC36-3S'7a sq- <br /> LEGAL DESCRIPTION(see tax receipt) .:�/2 - 341 - <br /> < I o <br /> ' DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ;9 ADDITION ❑ PRIVY ❑ r'l. CD � <br /> TYPE OF PERMIT(S): 11 Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ S BDIVISION ❑ S. <br /> n <br /> STRUCTURE/ADDITION USE: DM4aD A)O/Ssij/)[1m#dA >l O%(LS ea ,.s<244C4 <br /> (Hon-(e/Cabin; Commerd Business; Bedroom;Deck;etc.) C <br /> BUILDING CONTRACTOR:��� ��G% <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 61/a X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 vwi <br /> C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n $ O <br /> 0 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 'A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C 0 <br /> NORTH(N). to ° <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 0 <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. ° <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO O <br /> BUILDINGS,ROADS,LAKE,LOT LINES. '�j <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. (T_ <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. ° t <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a �rr4 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. P \ <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. ?rz:) <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. SLvb !" � /,'"v 11. 1( v✓ /U� p -0md0000 CL m <br /> 6. This structure to be used as private residential a- ; H H O ; 3 <br /> N O 10 <br /> 7garage/storage only. Not to be used for human Z : <br /> " <br /> _ y: m <br /> 1labitation. „te and to the best of my g O <br /> I declare that this application (Includir>t --.__-•- ••-- ---•• - -•••• C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of i;.� <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- m <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 unty cials charged with administering county ordinances or other m <br /> authorized person to v acts s to the a ove scrib prelAses at any reasonable time for the purpose of inspection. -n <br /> m : <br /> m : <br /> SIGN HERE <br /> (sign r ow r nr IdingCP <br /> ntractor) ,(date <br /> ZONING ADMINISTRATOR N H W H <br /> (N71 (N71 N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 0 <br />