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Burnett bounty 7410 Co. Rd. K, No. 102, Siren,WI 54872 6w,, <br /> APPLICATION FOR LAND USE PERMITS rainy Administrator o 0 <br /> 3 <br /> r <br /> N <br /> J N <br /> OWNER ,4 <br /> C. Q TELEPHONE a <br /> HOME ADDRESS h/� <br /> / I OOc� <br /> EMERGENCY/FIRE NUMBER C�a�� � h <br /> ROAD NAME <br /> t <br /> LEGAL DESCRIPTION (see tax receipt) ed <br /> E4- 6 8 3 3- <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ pRIVy ❑ (� N <br /> TYPE OF PERMIT(S): v y o <br /> FILLING/GRADING ❑ CAM ING UNIT ❑ SUBDIVISION ❑ c ' <br /> 0 <br /> n <br /> STRUCTURE/ADDITION USE: X ra, ( U/ o, <br /> Home/Cabin, Commercial Busl ess; Bedroom; Deck;etc.)) ' <br /> BUILDING CONTRACTOR: S > w <br /> lir <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR � � ~ <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T 3 <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) M H <br /> c <br /> CD <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m z <br /> n m 'o <br /> NORTH(N). C m <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF v <br /> LAKE,STREAM OR RIVER AND MEASUREMENT OWETLAND <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND RAINFIELD(DF),AND ALL DISTANCES TO <br /> P <br /> BUILDINGS, ROADS,LAKE, LOT LINES. l <br /> S. 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 C; <br /> MUST BE SIGNED AND DATED BY THE OWNER. h 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 <br /> NEEDED. 0 o <br /> Ct <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS F PERMIT: 0 <br /> 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60DAYS OF PERMIT <br /> ISSUANCE.2. REMOVAL OR CUTTING OF TREES AND Q <br /> 3. NO GRADING OR SHO ELAND ALTERATIONS AREN <br /> ALLOWED UIS I LESSS SPCTED OEC F CALLNG YLINE. <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> S TBACK AREA. <br /> / /) s ��1)I <br /> 6. ec�-Y �r�p e�-ty /,ham y 63' X -0 0 r i o? o rn <br /> , t 1�I /brri �,� // \�� Cy�yfl I' �IAR_ Of r�J�� m 4 3 coL m a ;a <br /> 7. -� um CM044m-r" `t h (aJr r/ N / l� o� N(r N O y 7 <br /> est of my �j <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the b <br /> o c <br /> ; A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and ac of m ' C <br /> a <br /> all information contained in this application(including any accompanying C <br /> that this information I am providing will be relied upon by the County of schedule)and i further declare that I recognize m <br /> Burnett Wisconsin in determining whether to is- G7 m <br /> sue 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 otherO <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. : P <br /> SIGN HERE m <br /> (sign tur of owner or buildirls c ntractor) (date) <br /> ZONING ADMINISTRATOR (/t <br /> v+cncntnv+w� <br /> oa.cNnoo <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br /> 0000000 <br />