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0'0 Y <br /> BuMbtt County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator -0o° o <br /> APPLICATION FOR LAND USE PERMITSCD <br /> s y�J1 <br /> OWNER 1 "N 1eknHONE n � <br /> O <br /> m <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER �J ROAD NAME <br /> see tax receipt) � 9 <br /> LEGAL DESCRIPTION ( t) — <br /> p ) rn <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ElPRIVY ❑ c <br /> o <br /> TYPE OF PERMIT(S): <br /> c � <br /> o. <br /> FILLING/GRADING ❑ PING UNIT ❑ 711-7 <br /> SUBB IVIS�IOON n <br /> S. <br /> STRUCTURE/ADDITION USE: �-J// / V / / t�0 (!/ -/ N <br /> 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) rn <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> x <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. t7 m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <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 v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF o <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. M <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 I <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN Cr <br /> W <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 I <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 /> 5. <br /> r <br /> 6. cImp M. m ' m a I ;'V <br /> ' mcuNil" cs3` <br /> 7. o u �� <br /> (!, _ rn ' m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my W [j c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o 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- <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. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. -n <br /> CP : <br /> CD <br /> SIGN HERE <br /> (signator owner or building con r) (date) <br /> ZONING ADMINISTRATOR ' ' ' ' ' ' rn <br /> to to to vi w v+ <br /> N K) 01 N N Ir Ir <br /> (A In O Ili Ir O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED Cs <br /> 0 0 0 0 0 0 <br /> 0000000 <br />