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Bttfnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator -U 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> y O <br /> OWNER �� �Gl�LTELEPHONE 5'2) 2 65`' <br /> MAILING ADDRESS <br /> 2 r � <br /> PROPERTYADDRESS � 1e <br /> LEGAL DESCRIPTION(see tax receipt) <br /> TYPE OF PERMIT(S): *�� cn <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> FILLING/GRADINGI 11 CAMPING UNIT ❑ SUBDIVISION E] n <br /> 5. <br /> STRUCTURE/ADDITIONUSE: L//// t-7 5,74e, LA. <br /> J ( ome/Cabin; C oVfmerfial Busine edroo ; Deck;et w <br /> BUILDING CONTRACTOR: (/{� -� r � '— <br /> d o <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLE R 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. *t — <br /> O <br /> Nr <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> -n cL <br /> TZ <br /> n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m � <br /> NORTH(N). C 74- <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 Z <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. o <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. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> F <br /> O 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o pa <br /> NEEDED. O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o <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 <br /> SETBACK AREA. � ❑❑❑��❑ <br /> r " I (D W0CD CL M <br /> r <br /> 6. 1 3 2120 yam <br /> 7. .fill - 82002 <br /> ((��� P T � <br /> I declare that this application (including any accompanying schedule) has �Tbt ii o the best of my G� N A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I b e a 1 and accuracy of m 0 EA c <br /> all information contain n is application(including any accompanying schedule)ZjQNWGr declare that I recognize m o m <br /> that this information am pr viding will by/relied upon by the County of Burnett Wisconsin in determining whether to is- m <br /> sue a permit. I fu er acc pt all liab+li hich may be a result of the County of Burnett relying on this information I am m <br /> providing in this pplica 'on. a perm' county officials charged with administering county ordinances or other d <br /> authorized pers n to h e ac s aboyfdescribed premises at any reasonable time for the pu s of inspection. . <br /> 't <br /> 0 : <br /> SIGN HERE <br /> n : <br /> no or ontractor) (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />