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Burrett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -u c� Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> o <br /> N <br /> CP <br /> CL <br /> /�,N- C <br /> OWNER 'T�eS ),OUV /TN wee l eR` TELEPHONE (1) 605-9,32-3361 v <br /> HOME ADDRESS G9 oS r. ffit LAre p S-7//o v <br /> r m <br /> EMERGENCY/FIRE NUMBER 21330 ROAD NAME C <br /> SU <br /> LEGAL DESCRIPTION(see tax receipt) k0T L"eS -T4WN n <br /> / y <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORYSTRUCTUREX ADDITION ❑ PRIVY ❑ rn o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING/❑ CAr�MPING UNIT ❑�SUBDIVISION <br /> ., ❑ 5 <br /> STRUCTURE/ADDITION USE: 7CJ/ o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) w <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR CD3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> 0 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p <br /> n G <br /> -n 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 /> 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 I 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 O <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. c <br /> o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q 0, <br /> NEEDED. 2 6, <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 I <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Z <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY d <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6 (OD <br /> B CL NO c: ii 5' 3 <br /> o .4 <br /> y: <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c p <br /> knowledge and belief it is true, correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of m C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize M m W <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have cc <br /> to the above described premises at any reasonable time for the purpose of inspection. T <br /> m . <br /> m <br /> SIGN HERE ��— W �— Z�—�— <br /> Or— <br /> (signature of ner or building contractor) (date) <br /> ZONING ADMI TOR �J 1/Y) <br /> 1") r)0 N <br /> Ut fTOn t»01 <br /> N C5 Ut fT N 00 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />