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Bumett County 7410 Co. Rd. K, No. 102, Siren,W154872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> y O <br /> N <br /> C <br /> OWNER � � � L) i C!5��1 TELEPHONE r o 41e <br /> O <br /> HOME ADDRESS ,,, cw) /fin <br /> \\, <br /> EMERGENCY/FIRE NUMBER S � ROAD NAME 1 I <br /> LEGAL DESCRIPTION(see tax receipt) S ((J t? (� ( �� l d(� S I Cn <br /> O fD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION PRIVY ❑ C/ <br /> TYPE OF PERMIT(S): Q _ <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ UBDIVISION ❑ 3� y V / n �_, <br /> STRUCTURE/ADDITION USE: Q C <br /> (Home Cabin; ommercial Business; Bedroom; Deck;e c.) m <br /> BUILDING CONTRACTOR: °' <br /> c <br /> A PLOT PLAN MUST BE PROVI ED ON AT LEAST AN SY:X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 �` <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 m G O\ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) OT n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m ;o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE y o <br /> NORTH(N). ao <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 I 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 C� <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 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 0 1 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ) 1 <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 /> 5. <br /> CD � � vQov <br /> 3 0 CDS <br /> O N <br /> 6. CD 0 _ <br /> Z : <br /> 7. p m <br /> V)1.: <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my " 2 c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o i <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m i 0 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- E <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 <br /> providing in th' pplic ' n. I agree to permit county officials charged with administering county ordinances or other <br /> authorized pe on o h e ccess t944e above descr'bed premises at any reasonable time for the purpose of inspection. m <br /> CD : <br /> CD <br /> SIGN HERE <br /> . (s' n re oMoor frig contractor) (date) <br /> ZONING ADMINISTRATOR . <br /> a <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />