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Burnet, ;ounty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N 5 <br /> C <br /> N <br /> OWNERJAMB �,��/kms TELEPHONE <br /> HOME ADDRESS R4 /j�)x F 7 7,, 66 S> v <br /> E <br /> EMERGENCY/FIRE NUMBERC�nFROAD NAME ke���✓' ) <br /> LEGAL DESCRIPTION(see tax receipt) <br /> �+ S . A c aloe)yr%C ! 6u..'sp— 4& co <br /> 0 <br /> e <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY c o <br /> TYPE OF PERMIT(S): <br /> Cr <br /> LN <br /> FILLING/GRADING ❑ CAMP G UNIT ❑ SUBDIVISION ❑ S. <br /> N <br /> STRUCTURE/ADDITION USE:C J 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) C <br /> BUILDING CONTRACTOR: �u . &tn� I�' ws Tvwc l lQN fir <br /> G <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n c <br /> M o � Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m '. o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE im n <br /> NORTH(N). W 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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. <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. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN a ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. VJ I <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. <br /> x -0 0r �O� L <br /> n " ii9' 3 <br /> 6. v Amo : �fc <br /> Z : y 2 <br /> 7. ° ' m: <br /> aE t m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G5 I C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a <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- d <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 p�+, ; m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T <br /> m : <br /> CD : <br /> SIGN HERE �� <br /> (sig ture o wller ► (date) <br /> ZONING ADMINISTRATOR <br /> tntnwwtnfn`CM <br /> N NN N N ill <br /> V1 VtONN POO <br /> O 0 0 0 0 0 0 <br /> T�114NSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />