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Buxnett Obunty 7410 Co. Rd. K, No. 1102, Siren,WI 54872 Office of Zoning Administrator - o z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> 0 <br /> fI1 .�. <br /> H <br /> C <br /> fD <br /> OWNER ✓ZQ/11/ ��� l�!`SSP/ TELEPHONE 7/ -_ O/LOO \ / � <br /> c 0 T <br /> HOME ADDRESS ;( [0 l SDfYJ7 C4ke /jGC[i'JAS v �j <br /> �-�,q12 0 � <br /> EMERGENCY/FIRE NUMBER y Q�Cj v/`v (� J I p77 ROAD NAMEtrn F <br /> LEGAL DESCRIPTION(see tax receipt)v,,tl0 f U./7 O. l;_0 Ste- /;Lr�-�-r'37"1 ((I�� y <br /> DWELLING/BUILDING 1:11�-�'GARAGE/ACCESSORY STRUCTURE ADDITION El PRIVY El 4) (n <br /> TYPE OF PERMIT(S): Q ' <br /> FILLING/GRADI ❑�CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: <br /> 'r Kms°/ eq 5. <br /> (Hoke/Cabin; Commercial Business; Bedroom; Deck; etc.) co <br /> W <br /> BUILDING CONTRACTOR: � �- <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR ,n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> LL fj� 0 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) frw b u 5 1r 5 h bM" I ` <br /> t � a <br /> In <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE Er <br /> NORTH(N). 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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. P <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. d O` <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. o <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHENa S <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> l <br /> 0 <br /> CONDITIONS OF PERMIT: Y <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 l <br /> PERMITTED. \ <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER O <br /> SETBACK AREA. <br /> 5. <br /> 6. Vv mCm ' o ' 3 <br /> 0 <br /> 7. 00 : i � <br /> -m t m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �j c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of i i mi i i C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 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 /> -1 <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 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. <br /> CDCD <br /> SIGN HERE d/6� az�- 6-17419 <br /> (signature of owner or buildin contractor) (date) <br /> ZONING ADMINISTRATOR . . . ` ` ` v+ <br /> to to 4a"w v <br /> N N (n NN 010 <br /> (A NO Vt N00 <br /> OWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br /> 0000000 <br />