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Bu.lett Cdunty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -CD o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> ^ r <br /> CD <br /> y O <br /> �R � � N <br /> OW"t1 TELEPHONE o <br /> L � � <br /> HOME ADDRESS/,Yo/ e' 7�S <br /> ���' g�✓� X30. R R /Jt -5-77 <br /> EMERGENCY/FIRE NUMBER (3�� ROAD NAME - — <br /> LEGAL DESCRIPTION(see tax receipt) L co <br /> _ yJ m <br /> e <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ y ° <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING 11CAMPING U IT ❑ SUBDIVISION ❑ n 5.; <br /> l / N <br /> STRUCTURE/ADDITION USE:�1O.IiGI�C�-Lam) C�(O /� Cl S <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) C <br /> BUILDING CONTRACTOR: Cal <br /> fi{ <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. p _ <br /> M Q <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O Q <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m ° V 0 <br /> NORTH(N). y 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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. I <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <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 /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN }�q <br /> NEEDED. 0 pW' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <br /> I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT QQQ��i ( Q <br /> ISSUANCE. (( ` <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. I <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. NNJ <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER @SETBACK AREA. <br /> 5. zv0rv�vV <br /> CDM. 0 m a m <br /> m c ° 3 <br /> Cn : <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c ip <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy ofogi <br /> ; S <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- m v <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 INS application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized pclir4n to have access to the d premises at any reasonable time for the purpose of inspection. 1-n <br /> � m <br /> SIGN HERE <br /> (signatur of owner orbuildin o ac afe)— <br /> ZONING ADMINISTRATOR <br /> wFnfnfnFnw <br /> N N N N N N N <br /> TOWNSHIP PE MITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />