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Burbett County 7.410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator v 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> 0 N \ <br /> 41 \1 <br /> n�/ / / r/ l n l n <br /> OWNER �� �/ IIx G TELEPHONE <br /> MAILINGADDRESS O <br /> (� <br /> PROPERTY ADDRESS 8 c &7 <br /> LEGAL DESCRIPTION(see tax receipt) C <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ rn <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT SUBDIVISION ❑ a <br /> STRUCTURE/ADDITIONUSE: GFI R 19 GF_ <br /> (Home/Cabin; Commercial Business;Bedroom; Deck;etc.) rn XJ <br /> r m In <br /> BUILDING CONTRACTOR: '- <br /> m <br /> m <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. T <br /> O <br /> .'0 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p n <br /> m <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO CO) a <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 <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. o <br /> v � 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERI(=¢/G7f O <br /> NEEDED. J �J <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. MAY 4 � <br /> CONDITIONS OF PERMIT: j ' g00Z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF FRMI�E T C J I q <br /> ISSUANCE. UM COUNTI <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINF,ZONI`vG 1 <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 /> 5. r\11 )SsUQi 5 —(�3 This structure to be used as private residential <br /> ) ; vaavv <br /> 6 garage/storage only. Not to be used for human ; , 000 o f m <br /> N <br /> habitation. ; c N y o 3 <br /> a <br /> 7. Z Vi N O 7 "a � <br /> O T ZI <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my —COA <br /> G) <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ID <br /> �i a <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ; m o : m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> G) : <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 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> o : <br /> M m <br /> SIGN HERE <br /> Q <br /> (signature of ow er or 'Iding contractor) (date) <br /> ZONING ADMINISTR OR <br /> fA di fA EA � N <br /> N (TNNOO <br /> T O N U O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />