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Burnet County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -V 0Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> F 0 ef/1 <br /> N <br /> KA <br /> CD <br /> C <br /> OWNER `_V�N f/ R�G� TELEPHONE (�i5) _as o <br /> HOME ADDRESS IQ5' I ST 1`1��- ,-D y-e}^, S487 o �D <br /> EMERGENCY/FIRE NUMBER 10511 ROAD NAME ST14TE -0wY I D � <br /> LEGAL DESCRIPTION (see tax receipt) s1GZ T 3EV 21-1 w 2 _38 —11 _ I(1 -0 d,LoID d (U I cn <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE X ADDITION ❑ PRIVY ❑ (n E5 <br /> TYPE OF PERMIT(S): \ <br /> FILLING/GRADING ❑ CAM ING UNIT SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: + U✓ 0 <br /> ome/Cabin, Commercial Bu ess; Bedroom; k; etc.) rn <br /> m <br /> BUILDING CONTRACTOR: K LCD <br /> d <br /> C <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. m <br /> ZI mcod <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> n <br /> T Z <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 <br /> NORTH(N). N o <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 /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N O <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 0 (N <br /> MUST BE SIGNED AND DATED BY THE OWNER. o f 1 <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° 11) <br /> NEEDED. <br /> -a <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o I <br /> CONDITIONS OF PERMIT: O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. 0 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY V� <br /> PERMITTED. 1 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> 5 SETBACK AREA. i/��� j/e /��/� � <br /> 6 �G <br /> is structure to be used as private residential � a ( O a a x <br /> / garage/storage only. Not to be used for human CD C N <br /> 7. habitation. o y �, A <br /> AI declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o �. <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize i <br /> 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 County of Burnett relying on this information I am <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to hav"ccess to the above described premises at any reago ( tinf it>e purpose of inspection. CDm <br /> SIGN HERE <br /> ignatureof o o it ctor d 7`'S, 4 <br /> ZONING ADMINISTRATOR <br /> A01 . QA- <br /> TOSHIP PERMITS MAY BE REQUIRC>� <br /> N� ' r <br />