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Bur4 it County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator -o G) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> t r <br /> i0 <br /> C <br /> OWNER rrGII and 04ra/E /4. ��l{/fYIKi'� TELEPHONE 0 <br /> o <br /> ID <br /> HOME ADDRESS��3�Q <br /> ' r m <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME ~ <br /> LEGAL DESCRIPTION(see tax receipt) ur <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ 0 <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: ��e <br /> (Home/Cabin; Co mercial Business; edroom;Deck;etc.) m <br /> BUILDING CONTRACTOR: sE L � <br /> e � <br /> � 1 <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. C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o. <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m I <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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. 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. O <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. A m Fo 1 <br /> w O 9 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN Cr <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <br /> ( <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT g , <br /> ISSUANCE. V <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY O, <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. Q <br /> U ;o -00 <br /> CD <br /> 6. CK <br /> 3 C N N G i 1 <br /> � n: a <br /> 7. 0 :fl <br /> O . <br /> m : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c C <br /> knowledge and belief it is true, correct and complete. I acknowledge that Ram responsible for the detail and accuracy of m Lr <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 00 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 lLLztt y <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ` m <br /> authorized person tA have access to the above desd premises at any reasonable time for the purpose of Inspection. of <br /> L- m <br /> SIGN HERE <br /> (signature o er r buil�ntr O (date) 7 <br /> ZONING ADMINISTRATOR <br /> �v+wwwcnw� <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 000000 <br />