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Burnett Ctsunty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -U C) �� z <br /> APPLICATION FOR LAND USE PERMITS 3 ZP <br /> OWNERoj <br /> e -a TELEPHONE <br /> d <br /> v <br /> HOME ADDRESS6;2 y pu l� 5� �� crc�� I <br /> M <br /> EMERGENCY/FIRE NUMBER G2 t// ROAD NAME <br /> 1 <br /> LEGAL DESCRIPTION (see tax receipt) PI� ��� 3s=39 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ PRIW ❑ m <br /> 0 <br /> TYPE OF PERMIT(S): Op a <br /> FILLING/GRA/DING 1:1 CAMPING UNIT SUBDIVISION El <br /> STRUCTURE/ADDITION USE: .STr�re"'a— /� y X � <br /> E. <br /> o �u <br /> /Home/Cabin; Commercial Business; Bedroom; Deck;etc.) caVY.:I <br /> BUILDING CONTRACTOR: ` eru�Y'j '- <br /> fif <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. C 3 (� <br /> x N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m p <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 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. o <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 /> S. 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 /> o � 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN0 <br /> Cr ( ' , <br /> NEEDED. W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. ( O <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. <br /> m �. m � ma m <br /> 6. )o CL <br /> a mCm 053 <br /> 7. Zi H 111Q '': i <br /> o <br /> N rn <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 I am responsible for the detail and accuracy of m <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognize C m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m p <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 y <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. -n <br /> �J <br /> SIGN HERE � • <br /> 7gna re Qf owner or buildin tractor) (date) <br /> ZONING ADMINISTRATOR w <br /> w . . . . . <br /> U <br /> N N (lINN VI U <br /> ut UtONUtOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />