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Burnett :otct;ty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator- l� o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> ^ r <br /> y O <br /> / c <br /> OWNER q4 1' ' Q TELEPHONE a <br /> d <br /> HOME ADDRESS? 3 S 7I&) 3� (� P 5-yy7 Z v <br /> o m <br /> EMERGENCY/FIRE NUMBER ROAD NAME �ly✓/a/t/ �� <br /> l <br /> 0) <br /> LEGAL DESCRIPTION(see tax receipt) / ?_ p ( m <br /> DWELLING/BUILDING 0 GA GE/ACCESSORY STRUCTUREZ ADDITION riJ PRIVY ❑ CO 0 <br /> TYPE OF PERMIT(S): c� <br /> FILLING/GRADING ❑ CAMPING U I ❑ SUBD ISION ❑ J� a <br /> STRUCTURE/ADDITION USE: / 7(J o <br /> (Ho /Cabin; mmercial Business; Bedroom; Deck;etc.) ur <br /> m <br /> BUILDING CONTRACTOR: vl t) az.. <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n — <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o pd <br /> M z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m :? <br /> NORTH(N). <br /> n <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 / <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. l J o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO t <br /> BUILDINGS,ROADS,LAKE, LOT LINES. Q <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N f� <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS �J <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. 0 4�1- <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 Q <br /> ISSUANCE. Q) <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 /> CD �. mm mOM <br /> Lm <br /> CD <br /> 7. z !" WM� 1pi <br /> o 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 I am responsible for the detail andaccuracy of m 0 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m ;U <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 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 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 thea ove described premises at any reasonabl9jime for the purpose of inspection. CD <br /> m <br /> m : <br /> SIGN HERE QUO V- kCX <br /> (signatu of ner or g contractor) 3Yp 78 6 (date) <br /> ZONING ADMINISTRATOR 77 <br /> wcwwtntnw� <br /> N NN N <br /> V1 UL"PP1 O V1 V1 O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />