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Burnett Ctiunty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r Q <br /> F O <br /> C _ <br /> OWNER �, T� t y-M Ft <br /> 1"1 TELEPHON 715 '7- QSS- v <br /> 1v m <br /> HOME ADDRESS fJ Box 7y3 Fre l C C 1 G w r `i y8 3 -7 v <br /> r m <br /> EMERGENCY/FIRE NUMBER 7/36 ROAD NAME FCC"\ C 0 <br /> SeC. 'rewn fd0 -<Prn C 14 OAKLAND SI4rCS <br /> LEGAL DESCRIPTION(see tax receipt)Lc f1I.2 4SIk ;L4^ 5/41. -Ttir 001/0-1t/ $!k t -c <br /> DWELLING/BUILDING R GARAGE/ACCESSORY STRUCTURE X ADDITION ❑ PRIVY ❑ Cl) <br /> 0 <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: e ry 14 e Mt• AC P o <br /> p. <br /> (Home/Cabin; Commercial siness; Bedroom; Deck;etc.) Cn <br /> BUILDING CONTRACTOR:ZoRCIenr W/Me $ <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3, <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> I� <br /> -7,DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) PP'I ,2,� O <br /> N <br /> O m <br /> , <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES 70 BE SHOWN OR DRAWN 70 SCALE. m m ;b2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE n <br /> NORTH(N). C <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 TO WETLAND AREAS. t 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 /> 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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN w ° <br /> NEEDED. �J <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <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. I 1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. Q <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER C <br /> SETBACK AREA. <br /> 5. <br /> z < 0onCL � m <br /> � . d � F <br /> 6. N C N w O ? <br /> 7. Z N N� f0 � <br /> O . <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 6- ' O <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m Lo' C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- O <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 <br /> p gin this application. I agree to permit county officials charged wi t rices or other m <br /> authorized person to have access to the above described premises at any r r r f inspection. m <br /> CD : <br /> CD <br /> SIGN HER t11 d' ' <br /> (si nature of a or bullding contra JUN ( (date <br /> ZONING ADMINISTRATOR <br /> N NNNN(lV1 <br /> (P (IiON(TOO <br /> TOW SHIP PERMITS MAY BE REQUIRED &0000000 0000000 <br />