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Burnett CtSunty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> C <br /> n1 <br /> '� a <br /> OWNERJ 'fn R Z £ TELEPHONECD <br /> ��6 8 0 v ��h <br /> r�p p <br /> HOME ADDRESS oC 1 O o 3 e- gQ i x TR� ( E w <br /> EMERGENCY/FIRE NUMBER �9Q3 ROAD NAMES 1. SRO e ��I L C <br /> RES <br /> O, G�00 <br /> LEGAL DESCRIPTION(see tax receipt) 46 l-r 7( /3 6/-7 <br /> 0 Q 1 Ra 0 We- m <br /> DWELLING/BUILDING ® GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ (n 0 <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE:�OL £ }t R IJ FOR 1 FIG' j 0 2S 0 <br /> y�(1 (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) (n <br /> BUILDING CONTRACTOR: B 4'I L.D I rt) & &Ie p <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <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 fD <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 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. 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. I Q <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N W <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS I n <br /> MUST BE SIGNED AND DATED BY THE OWNER. f <br /> v � � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN "- <br /> NEEDED. UI <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> 0 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. I C� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. J <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 /> b / v � vfv m <br /> 6. ; n " : " 3C � o� CN`�� o 0o <br /> 7. U <br /> = v, : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 0 A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of a <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize <br /> CD m p <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- I <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. 1 agree to permit county officials charged with administering county ordinances or other <br /> ID <br /> authorized person to hav access to the above described premises at any reasonable time for the purpose of inspection. T <br /> CD <br /> SIGN HERE <br /> (signature of o e;'o bugrrKg contracto (date) <br /> ZONING ADMINISTRATOR i <br /> TOWN PERMITS MAY BE REQUIRED <br /> q <br />