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Burnett C-ounty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> gJ <br /> N <br /> N <br /> C <br /> (D <br /> OWNER rqe q e, `,yam //f TELEPHONE s�� _, �p7y3�/ o <br /> HOME ADDRESS �/ 3 9' L�9 l 1 / Qiyl j,�r Y (-�i't . S7p J <br /> !v +� <br /> EMERGENCY/FIRE NUMBER � ROAD NAME 4 L� <br /> LEGAL DESCRIPTION (see tax receipt) �� �i_[— cn <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ rn <br /> TYPE OF PERMIT(S): Q ' <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION ❑ �' <br /> N <br /> STRUCTURE/ADDITION USE: &Vwtkl <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) rn <br /> m <br /> BUILDING CONTRACTOR: ro <br /> 4 <br /> a <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'h X 11 SHEET OF PAPER. ANY INCOMPLETE OR3. <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T - <br /> O W <br /> A y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) ,n 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 m AS \� <br /> NORTH(N). 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 /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <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 Ir- <br /> THIS6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN — °NEEDED. 'PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. (R I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. �1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY (� <br /> PERMITTED. )U <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> m 'a w rr' >OnOm <br /> 6. v 3 CL� <br /> -0 C: <br /> 7. o : m T� <br /> - (n A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ) <br /> knowledge and belief it is true, correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of m <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize ID <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,,,result of the County of Burnett relying on this information I am m <br /> providing in this applic , n. I agree to permit co officials charged with administering county ordinances or other <br /> authorized person toj4yf access to the abo es ib prem' easonable time for the purpose of inspection. <br /> m : <br /> mCD : <br /> SIGN HERE S <br /> (signature f o er Kr building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> T NSHIP PERMITS MAY BE REQUIRED <br />