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BurWtt Ccmmty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -V o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> /)1K 5, �h A�eOw! tild Kc h, <br /> N O0 <br /> f/1 <br /> OWK • koqAo L leQjc� �F� TELEPHONE ��- 381'^1(07n <br /> J <br /> v � � <br /> /. / m <br /> HOME ADDRESS 2Q W/SC Z +q o 2 JO,K� �Vo/b <br /> 0 g <br /> EMERGENCY/FIRE NUMBER ROAD NAME L C¢ <40� I <br /> eS4A-fe_S Lat a391 " '17� Du <br /> LEGAL DESCRIPTION(see tax receipt) /^t� 6Lk+ 1(ht I I St Add SF;Py;eS �S"I ' y <br /> TYPE OF PERMIT(S): <br /> DWELLING/BUILDING 19 GARAGE/ACCESSORY STRUCTURE 1:1ADDITION ElPRIVY 1:1l o0 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION /` a <br /> � <br /> STRUCTURE/ADDITION USE:�A'b1'� /40fF ( l l 1!J <br /> (Home/Cabin; CommercW Business; Bedroom; Deck;etc.) rn <br /> m <br /> BUILDING CONTRACTOR: <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. ^ <br /> x <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m n <br /> NORTH(N). y 3 <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. c <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. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS Q <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 MAYBE DONE WHEN q 0, <br /> NEEDED. <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. 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. v <br /> 4. NO STRUCTURES, INCLUDING RETALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA <br /> 5 . <br /> 9d� ,�- <br /> s. C a m <br /> C N m > > 3 <br /> 7. / Z <br /> c <br /> - rn: m m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c p <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of o S <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- O <br /> m <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 d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other O m i <br /> authorized person to have access to the above desibed premises at any reasonable time for the purpose of inspection. m <br /> m <br /> SIGN HE v2 7 <br /> (signature f neror ll actor) (date)9 <br /> ZONING ADMINISTRATOR J� / . . . . `. to <br /> N N V I N N U I V 1 <br /> ut NON V1OO <br /> OWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />