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BuMett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator T a o <br /> APPLICATION FOR LAND USE PERMITS 3' <br /> N O <br /> H <br /> USG TELEPHONE 7/S ��GJ 7✓v O \' <br /> OWNER <br /> HOME ADDRESS ��L�9� 3 //{ lea' <br /> !� <br /> 0 <br /> EMERGENCY/FIRE NUMBER0 7 /3 ROAD NAME /G� \ <br /> y Q <br /> La i �d W-7 �o ► CD <br /> �, <br /> LEGAL DESCRIPTION(see tax receipt) a / /(�C f V i V <br /> 9J <br /> rrppt� s <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ILEI ADDITION ❑ PRIVY ❑ <br /> rr <br /> TYPE OF PERMIT(S): <br /> rr <br /> FILLING/GRADING ❑ CAMPING UNI ❑ SUBDIVISION ❑ �. <br /> 300 <br /> STRUCTURE/ADDITION USE: CSL ' <br /> (Home/C bin; Commercial B iness; Bedroom;Deck; etc.) <br /> BUILDING CONTRACTOR: S'EG/C <br /> v <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. vN <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n a <br /> -n O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m ;o2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m o <br /> NORTH(N). y <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 L o <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. o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS 2 <br /> o <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN g ° <br /> NEEDED. <br /> Z O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <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. <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 /> p <br /> SETBACK ARTA".�y G EZiU �. y C� <br /> /1 An. ���I/fµa (fit 9 x -0 0'r- O O <br /> 5. CDm m a m <br /> / fD 9m C n mm 0 3_ <br /> 6. a <br /> N N 0 1 <br /> O <br /> 7. m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of rny C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy ofCL <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize : 6: <br /> v <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <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 ? 2 <br /> CD <br /> authorized person to have access to the above cribed premises at any reasonable time for the purpose of inspection. - <br /> m : <br /> SIGN HE (date) <br /> (sill re of o er or building con c or) <br /> ZONING ADMINISTRATOR '^'^4A`^'A`A <br /> N NM N N ul u1 <br /> Vn Vn 0(A Vn 00 <br /> O 0 0 0 0 0 0 <br /> T NSHIP PERMITS MAY BE REQUIRED <br />