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BuMett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N <br /> C <br /> D <br /> OWNER ` TELEPHONE v : <br /> HOME ADDRESS �^ a�4 F <br /> r CD <br /> EMERGENCY/FIRE NUMBERati <br /> ROAD NAMEJRN I o <br /> LEGAL DESCRIPTION (see tax receipt) <br /> �� '^f cn <br /> DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ rn ° <br /> TYPE OF PERMIT(S): ❑ `v <br /> FILLING/ D G CAMPING SUBDIVISIO a <br /> m <br /> STRUCTURE/ADDITION USE: ' <br /> (Ho /Cabin; Vomercial usin ss; room; Deck;etc.) U) <br /> m <br /> BUILDING CONTRACTQS-. <br /> m <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/3 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> 0 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. Z <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n �/ <br /> ,n <br /> ?� OZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m M <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y n <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 O <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS C 0. <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> t7 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN T oV�J1 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> c <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ill �., XI <br /> ISSUANCE. Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORE <br /> L 1 i pd <br /> 0 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALY <br /> 4. NO SPERTRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQ D WATER' _' <br /> TBAC/K AREA. <br /> 5 <br /> t n r D t7 D O <br /> _ 1 ��2C-Q(dL� - 1�- �E. J 200 3 Q m a a x <br /> 6. a <br /> N N ^ — <br /> �. e8 t1)rda�h reem� �. C�. ( �Rl�_- C _ 0 . <br /> CD <br /> � : <br /> ZQ ei., NJy ° A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to st of my ` 0 2 c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize ` <br /> Pp (� 9 Y ) 9 � `° � p <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 a ree to per count officials charged with administering county ordinances or other <br /> authorized person to have access It the abo scri ed premises at any reasonable time for the purpose of inspection. T <br /> m <br /> SIGN HERE <br /> ( ' torp of owner or building tr ctor) (date) � <br /> ZONING ADMINISTRATOR �� � <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />