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9ernp <br /> Burflett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS . <br /> CD o <br /> OWNE <br /> m <br /> HOME ADDRESS / <br /> Zm001 of o Q <br /> EMERGENCY/FIRE NUMBER J qR0 ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt)sle /�" 3 / ��' QT .3 �/ Q)!l "L C m <br /> 11� 0 <br /> DWELLING/BUILDING 1:1GARAGE/ACCESSORY STRUCTURE 11 ADDITION El PRIVY ❑ W rn <br /> TYPE OF PERMIT(S): j Q <br /> FILLING/GRADING ❑ CAMPING UNIT ® SUBDIVISION ❑ (� n <br /> STRUCTURE/ADDITION USE: &'7e C /D x / V / J �/7 0 <br /> (Home/Cabin;;Commer,ciial Business; Bedroom; Deck; m <br /> 7etc.) <br /> BUILDING CONTRACTOR:_5Ccc� � �/ L'/�/7t T /!/�G /� 9. <br /> M <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR B <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> IZI N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> T 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 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <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. `L <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N Q <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. o <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN 0f' <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c C <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 /> SETBACK AREA. <br /> 5. �C Kls� X 'V0r- o� ov <br /> CD M. m 2i `° m <br /> 6. w': m C:CvNi 0n 053 <br /> 0 <br /> Z <br /> 7. ' 1< ° 1 <br /> o A <br /> = y : <br /> In <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m '• '• C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> sue a permit. I further accept all liability which may be a result of the Cqun In on this information I am m <br /> providing inthis application. I agree to permit county officials charge i 'ni s or other m <br /> person erson to have access to the abovedescribed remises ata I h r spection. -n <br /> SIGN HERE C/�/l%► I rn �" _ / v, E E <br /> (signature o nerorbuilding con tor) Lr (da / <br /> ZONING ADMINISTRATOR ^ . . . <br /> UNTY <br /> N NN N MP UN <br /> ZONING � ao � <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />