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DNyup <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator � o 0 <br /> 9. <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> --�(»zj —rJOol— X330 o 4S- <br /> CL <br /> S-a !/1 <br /> OWNER :t�, TELEPHONE �+ _ 0) <br /> m <br /> ,�^ W �' O <br /> HOME ADDRESS �O ry <br /> EMERGENCY/FIRE NUMBER w-1 5a© ROAD NAME �P� �.1�• R <br /> hhI <br /> LEGAL DESCRIPTION(see tax receipt) <br /> �(( 0 <br /> DWELLING/BUILDING ❑ ARAGE CCESSORY STRUCTURE ILJ. ADDITION ❑ PRIVY ❑ c 0= <br /> TYPE OF PERMIT(S): or <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5 <br /> N <br /> O <br /> STRUCTURE/ADDITION USE: <br /> (H a Cabin; Commercial Business; Bedroom; Deck;etc.) ` m <br /> UI DICONTRAC OR: <br /> kt <br /> v <br /> R <br /> A PLO PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. � m <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n ii <br /> :2 0 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m� <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). 3 <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. ° <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 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0, <br /> MUST BE SIGNED AND DATED BY THE OWNER. v 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q <br /> � W <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 <br /> ISSUANCE. i <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 /> 5 hSET/B)K6 <br /> rM <br /> l l CD (D <br /> This structure to be used as private residential d <br /> m � n N N>> 3 <br /> 6 garage/storage only. Not to be used for human ;~ : 3 c y <br /> habitation. Z : u ; (2 <br /> 7. <br /> ? ; y i m <br /> I 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 n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize M Mm <br /> that this information I am providing will be relied upon by the County of By�Wisconsin in determining whether to is- <br /> sue a permit. I further accept all liability which may be a result of the Gou' Burnett relying on this information I am <br /> providing in this application. I agree to permit county officials charged wit _Wsteriing,county ordinances or other m <br /> authorized person ave access tot above desc bed premises et any r asonablelime_kor.the purpose of inspe tion. T <br /> CD : <br /> P � m : <br /> SIGN HERE c C <br /> (signature of owner or builds f nttractor) N` ;� (date) E <br /> NISTRATOR in <br /> ZONING ADMIvo cn to w <br /> N Vt O Vt f7i O O <br /> OWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br /> 0000000 <br /> v <br />