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Burnett C'bunty 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> rn <br /> OWNER <br /> �A /TELEPHONE 73-11 <br /> HOME ADDRESS F0 � _ <br /> 9 <br /> + r <br /> 0 <br /> EMERGENCY/FIRE NUMBER R'00 -3 ROAD NAME Z )Ale R.1- 1 <br /> LEGAL DESCRIPTION(see tax receipt) k/o I& / '�� GL - rC�S <br /> DWELLING/BUILDING LJGARAGE/ACCESSORY STRUCTURE ILL ADDITION ❑ PRIVY ❑ (n <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ o <br /> N <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: fit <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. <br /> itf y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <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 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. P <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. a' o <br /> O (� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Cr <br /> NEEDED. <br /> / <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Zo <br /> CONDITIONS OF PERMIT: � <br /> J� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <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 /> -Ddd vov <br /> 6. Cl''1,cjgc&'1 -z L�zlvefhar>) - /0�� -j%r, I.- 0 ^ o MX <br /> 7. SI )of-- 11`0 t? Z N � � °� =io : _ <br /> ! rn: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my t 1 c iQ <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o it C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- v <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 m <br /> authorized person to ve access to the above described premises at any reasonable time for the purpose of inspection. -n <br /> CD <br /> m : <br /> �-9 _ g� <br /> SIGN HERE <br /> (signature <br /> 'of owner <br /> �or�building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> N 01 N N N V1 <br /> V1 NONIr OO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 0000000 <br /> 0000000 <br />