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Burnett Co'ttnty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o <br /> - APPLICATION FOR LAND USE PERMITS 3. <br /> N <br /> C <br /> OWNERi� <br /> HOME ADDRESS 9 il <br /> r <br /> 0 <br /> EMERGENCY/FIRE NUMBER -�?�1/�S � ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) 3 j A i// e'&�AL/- 5 e- 50 1)��� � W 0 <br /> YY /r r <br /> DWELLING/BUILDING ❑ GARAGE/� o <br /> SORY STRUCTURE � ADDITION ❑ PRIVY ❑ 16 � � <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> m <br /> STRUCTURE/ADDITION USE: a xB 0 <br /> (Home bin; Commercial Business; Bedroom; Deck;etc.) <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 -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) <br /> n C- <br /> 7! o Z p <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m t„�v <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> P <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. o l <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q <br /> NEEDED. W <br /> Ell <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 a <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. &",,A }). ..� <br /> / m -0m r. MCL�cFm <br /> iP <br /> 'CD CL •'0� �= <br /> 6. � cm 093 <br /> Z : <br /> mo <br /> 7. <br /> ' N �� <br /> _cr . : 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 o <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize (D 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 /> 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 have access to the above described premises at any reasonable time for the purpose of inspection. -n <br /> CD <br /> CD : <br /> SIGN HERE ` -' o C3 <br /> (sig ilding con actor) (date) <br /> ZONING ADMINISTRATOR v+w yr cn rn yr <br /> N N (TN N(n (T <br /> N V O N M 0 O <br /> TOWNSHIP PERMITS MAY BE REQUIRED Co c 0 o 0 c c <br />