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BurnF.t County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Adminis ator -0 0Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N <br /> N <br /> h C <br /> OWNER v TELEPHONE <br /> Q °� C <br /> HOME ADDRESS Q, 1 ( �Qt� , i 1 n l�r ! !„ ��� <br /> EMERGENCY/FIRE NUMBER ��� ROAD NAMEJ—O I S I�A I jE •` m <br /> LEGAL DESCRIPTION(see tax receipt)P�+ L S W C <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE^ ADDITION ❑ PRIVY ❑ 0 <br /> TYPE OF PER <br /> ur 111 <br /> Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ Q. <br /> H `1 <br /> STRUCTURE/ADDITION USE: 6 {aQo <br /> w l� (Home/ bin; Co mercial Business; Bedroom; Deck;etc.) Cn i <br /> BUILDING CONTRACTOR: <br /> /LfdL <br /> 0 <br /> v <br /> PLOT PLAN MUST BE PROVIDEDco <br /> I ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T <br /> LLEGIBLE SLOT PLANS WILL BE RETURNED. <br /> o c <br /> z <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p m <br /> m o, <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO M O <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. c <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 mow, <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR,ETC.,THE PLANS 1 N <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> v 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHENa 0, <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z i R <br /> CONDITIONS OF PERMIT: P "I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. U <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 V <br /> S,(ETTBB�ACK AREA. <br /> 5.6. 0M CL CX7 <br /> 7. Z : " CWD 791 <br /> o W <br /> C') : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c p <br /> knowledge and belief it is true, correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of m 04 ic <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize �t �co 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 /> 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. m <br /> �1 CD <br /> m <br /> SIGN HERE <br /> t <br /> =SHIP <br /> or /. (date) <br /> ZONING ADMINISTRATOR <br /> N N (n N N fT N <br /> Cn NON [TOO <br /> BE REQUIRED 0 0 0 0 0 0 0 <br />