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bytulle <br /> Barnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v L7r�z <br /> APPLICATION FOR LAND USE PERMITS 3 �1 <br /> N � <br /> C <br /> OWNERJ t� V ome I TELEPHONE ��I - y - SSy O <br /> HOME ADDRESS 1�1t'ooZ NvAve. , Af�yCl AV 9 <br /> d� <br /> EMERGENCY/FIRE NUMBER 3-7 S-3 ROAD NAME L.,570R e*IL' <br /> LEGAL DESCRIPTION (see tax receipt) 5 e'G-�Or1 I- go v LO+. rn ) �� SIV <br /> m <br /> � <br /> � e. <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE 1:1ADDITIONIJ -y PRIVY ❑ (0 0 <br /> TYPE OF PERMIT(S): <br /> �'/Ir s 5 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑STRUCTURE/ADDITION USE: <br /> � <br /> - CL'� <br /> (Home/Cabiinn; Commercial Business; Bedroom; Deck; tc.) m <br /> BUILDING CONTRACTOR: 1 /Ce As1,1Ct c, <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 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> M y Q <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 < <br /> n a <br /> m 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 m <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO Cl) <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. LlP <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. O <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. c <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 /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SCAN ONSITE VERIFICATION MAYBE DONE WHEN q 0 <br /> NEEDED. C <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <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. <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 f� <br /> SETBACK AREA. C�7/ <br /> 5. <br /> zM0 r,CD M 10 Q m <br /> CD <br /> 7. o N < : A <br /> _m m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my of Cr C <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of o E <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ( m m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 0 <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 application. I agree to pe it county officials charged with administering county ordinances or other CO <br /> authorized person to have access to t4gooffiove described s at any reasonable time for the purpose of inspection. T <br /> CD <br /> C� m <br /> SIGN HERE <br /> (signature owner or building contractor) (date) . <br /> ZONING ADMINISTRATOR4011 <br /> �4tjorj , o <br /> 0000 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 000000 <br />