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Burnett Cpunty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 c) z <br /> APPLICATION FOR LAND USE PERMITS El <br /> CD <br /> OWNERf TELEPHONE <br /> A <br /> NI�e kir o I (�clae 1�1( �u <br /> HOME ADDRESS 7C�l I I I I QrTTjT <br /> r o0 <br /> EMERGENCY/FIRE NUMBER Lf'S'7�� ROAD NAMEO().Bd 14 o <br /> LEGAL DESCRIPTION (see tax receipt) 1 b—40—I LQ4 I CS m V 10 P25b \ m <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE 1:1ADDITION ❑ PRIVY ❑ y o <br /> TYPE OF PERMIT(S): ' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ ® n <br /> �un4 -asP b -sb T+4E&& &� ' 6 11 <br /> STRUCTURE/ADDITION USE: 0 <br /> (� (Home/Cabin; Commercial Business; Bedroom; Deck;et .) rn <br /> BUILDING CONTRACTOR: <br /> m <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 77 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> O <br /> M <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> T o- <br /> TZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n 0 W A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m CD <br /> NORTH(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 Z <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 �v <br /> BUILDINGS, ROADS, LAKE, LOT LINES. , O <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR,ETC.,THE PLANS 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. w� o <br /> o I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> CONDITIONS OF PERMIT: P <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. ( _r <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.,ALLO ED WITHIN THE REQUIRED WATER <br /> 5. <br /> SETBACK <br /> K AREA. <br /> 0 <br /> CD mdCOD00 (D f <br /> 6. m 3 n `r �: m <br /> 7. Z : y CD <br /> o its m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of �. <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize C m <br /> /�j . CD 0 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 1 <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 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. (D <br /> n : <br /> (D <br /> (D <br /> SIGN HERE <br /> - Q -C) <br /> ign re of owne r (ding contractor) (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />