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Burp.-.At County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N <br /> OWNER TELEPHONE 7/S y/ 7L' E <br /> J <br /> HOME ADDRESS � r m <br /> CD <br /> r <br /> 0 <br /> EMERGENCY/FIRE NUMBER -7_l ROAD NAME POq <br /> �3Lo ,-d +te 11'r r'--1 Q <br /> ' / P <br /> LEGAL DESCRIPTION (see tax receipt) -SES� �S — �— 7 ` U <br /> CDa <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION Q PRIVY ❑ CO <br /> TYPE OF PERMIT(S): C <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: A'Ry P �7 ✓Ol pe(C 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) CO <br /> m <br /> BUILDING CONTRACTOR: SS IF � <br /> iu <br /> CD <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/a X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> O — <br /> �l N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m B <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <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 C <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. v ? io <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. T <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. a <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 <br /> ISSUANCE. rrr� <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 /> /` 0 < o m <br /> 6. ` PID mmCDW <br /> i� � t0 7. ° G) m <br /> c"— <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 2 A <br /> : 0 <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o 0 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize2 <br /> ID v <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 7 <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 this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described remises at an reasonable time for the purpose of inspection. m <br /> p P Y P P P _n <br /> CD <br /> SIGN HERE <br /> / (signature of owner or ing contractor) (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP ERMITS MAY BE REQUIRED �� 1 <br />