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4urnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> OAK APPLIEATIQN FOR LAND USE PERMITS ��� 3 <br /> �ZEso►2T'j a <br /> L <br /> OWNER � NTTD� 9Q� y o <br /> �p <br /> ELEPHONE 7/.S <br /> HOME ADDRESS 3 t/,��V (Af ��� �}yQ �� /iC � OU^47 CJS �� )LL 0 <br /> r CD <br /> EMERGENCY/FIRE NUMBER ROAD NAME V6,6 (� <br /> c� <br /> ca <br /> LEGAL DESCRIPTION(see tax receipt) 6, �, —� / v, M <br /> m �} <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE El ADDITION PRIVY ❑ U) o <br /> TYPE OF PERMIT(S): `aCT <br /> Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISIO ❑ c <br /> N <br /> STRUCTURE/ADDITION USE: SO C'-G 1 � `Q o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) m <br /> BUILDING CONTRACTOR: <br /> v � <br /> m <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 /> A N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n C <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m �Zp <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO rn <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. <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q 0 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z b <br /> CONDITIONS OF PERMIT: c , <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 /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIR TER <br /> SETBACK AREA. <br /> 5. -4 w/4� r O O <br /> 6. 9� �' <br /> �d <br /> CL M <br /> m o E 0 3 <br /> 7. 2 ' ,996 /`:. �, <br /> I declare that this application (including any accompanying schedule) has been examined by me and (cri my C <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and cur f m g <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- 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 iu <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T <br /> - : <br /> m : <br /> SIGN HERE r— d R—Z ^9B . <br /> (sign a of owner or building co a or) (date) <br /> ZONING ADMINISTRATOR • • • . . <br /> »en En vi Fn 4A <br /> N <br /> ttN (71NNNtT <br /> N MO0 (n OO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />