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Burnett l:oufuy 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> ' r <br /> - y O <br /> N <br /> OWNERGI/ZC'6�!/ FZZLJ�yj TELEPHONE <br /> }, m <br /> HOME ADDRESS <br /> J0?33 �.cu.�-�� �%u sI• � 2euczi�l `1, i �� 3 o <br /> r <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME 1 <br /> LEGAL DESCRIPTION (see tax receipt) <br /> 53� <br /> m <br /> DWELLING/BUILDING g GARAGE/ACCESSORY STRUCT E ❑ ADDITION ❑ PRIVY ❑ (A o <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION E] N <br /> STRUCTURE/ADDITION USE: /J17M 0 <br /> �j 'Home/Cabin; Commercial Business; eBedroom; Deck;etc. rn <br /> BUILDING CONTRACTOR: /d// ���/J1I� U V/J m <br /> Z � <br /> m <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> M m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n <br /> -n o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m n <br /> NORTH(N). ca f o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO rrl L 3 <br /> a <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. r 9 <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 ( g <br /> MUST BE SIGNED AND DATED BY THE OWNER. a I <br /> v 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> ) <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT d <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. c ' <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. v � o Q v v <br /> fm <br /> 6. m � 3o nm xn "= ;a <br /> .� N C N N O <br /> y N O : O 0 <br /> 7. om_U) <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 0 c: 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 m m0 <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 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. T <br /> CD <br /> CD <br /> ? <br /> SIGN HERE <br /> (si re of or building contractor) (date) <br /> ZONING ADNNISTRATOR VOL/S (� <br /> TOWNSHIP PERMITS MAY BE REQUIRED ��, � ���1� ,�J) <br />