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F-urnett'County 7410 Co. Rd. K, No. 102, Siren,W154872 Office of Zoning Administrator -a Z <br /> APPLICATION FOR LAND USE PERMITS 3. o .0� <br /> N <br /> OWNER r)ob�a -r.a U�eS� TELEPHONE <br /> HOME ADDRESS1 I g G rYl a A J S c�i hl D r~ O <br /> s <br /> EMERGENCY/FIRE NUMBER <br /> 110-90 OAD NAME ' S �� <br /> LEGAL DESCRIPTION(see tax receipt) Lot; 6 V 0 Lbt 2 Se t-t� 10 7 4a N t'46) bikk 010or <br /> DWELLING/BUILDING 1:1GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ ur o <br /> TYPE OF PERMIT(S): ,1 TI �K l <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ IY�'`;'l"`��^1 0 Qyr a <br /> STRUCTURE/ADDITION USE: !Z, I�u�l X �^ vl l�� <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) rn O <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> O <br /> ;a N O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> n a <br /> n v O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Z� <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 16 <br /> NORTH(N). C 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO rn 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. ° <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. 5 e <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN a o <br /> NEEDED. Ct <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. V <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 -k /_ w <br /> M0 N°'r Q O <br /> m <br /> a m C y y o S 3 <br /> 7. Z wM <br /> o : < : XI <br /> �' <br /> I declare that this application (including any any accompanying schedule) has been examined by me and to the best of my �j O <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize �m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- \ p <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 I m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have Keess to the above described premises at any reasonable time for the purpose of inspection. <br /> m <br /> SIGN HERE — Q ,� 4" <br /> (si ature owner or buildin ontractor) (date) <br /> ZONING ADMINISTRATOR <br /> �4694644A <br /> NNUI N NNN <br /> N N OtA°100 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />