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Burnett Bounty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator a 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N <br /> OWNER �� S f-- A TELEPHONE &> �Z d I X—1°73 � k>� <br /> /) 1 ` ' � O <br /> HOME ADDRESS 63 b O A 2�+` u,n' /� / I I I �� <br /> �/ �r- <br /> 16 m <br /> EMERGENCY/FIRE NUMBER ROAD N ME " " � i e <br /> o a 3 o n 2 z� y <br /> LEGAL DESCRIPTION(see tax receipt) r T (� Z �2(i, 'Z� -rwio"f0 N A9P g'z' <br /> ^ �, o <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE U ADDITION LJ PRIVY U �l <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING 11CAMPING UNIT ❑ SUBDIVISION ❑ N. <br /> �/,!Ir(/ SAV/ o' <br /> STRUCTURE/ADDITION USE: c <br /> /C} <br /> (Home/Cabin; <br /> Commercial Business; Bedroom;Deck,etc.) <br /> BUILDING CONTRACTOR: �, ✓ v '^' �� \"U <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n n <br /> T O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C o <br /> Sri <br /> NORTH(N). N <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASU ORDINARY HIGH WATER MARK(OHWM)OF J Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT T WETLAND AR <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC A INFIELD(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 o Q <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN g <br /> NEEDED. T <br /> Z <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 1 I , cl <br /> ISSUANCE. 'QV (� <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 /> ;a -0OrTH� <br /> 5. m o. a, a m m <br /> 3 n Sic' c _ <br /> i//�,-. �L/,1 /KJ -5 m C N fA > > 3 <br /> 6. ��f ) Vril ( Jr — O� IV o : N :1'4 <br /> 7. , Z:Jrr—q+-.,Gm =cn i ` i m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 9 : C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of : m m - <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize o <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 county officials ch r ri. g count ordinances or other i '• <br /> ose of Inspection. <br /> authorized person to h ess to the ab ve described premises na _ m <br /> SIGN HEREQ i d te) <br /> (signs re o ner or building contractor) AY 2 • ' <br /> ZONING ADMINISTRATOR <br /> N N(n N N ut <br /> ETT COL jNTY 0 0 0 0 <br /> v, o SA� , o <br /> O 0 0 <br /> TOWNSHIP PERMITS MAY BE REOLM KING <br />