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Burrett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> rn o <br /> 41 T <br /> OWNERy� <br /> �1�-r"� �VC TELEPHONE <br /> HOME ADDRESS �© f✓.ly 3 iq� t,./t t4j Sy �c�3 Q O j <br /> EMERGENCY/FIRE NUMBER ROAD NAME,_LpY;ls+. L (� <br /> 69 CS M 3 709 -thi O oAkuw� raw �{- W e`a� i quv <br /> LEGAL DESCRIP ION(see tax receQj <br /> ipt) tUY►i /_µ� P-16� ,-N OF OA A� y <br /> W m <br /> DWELLING/BUILDING K GARAGE/ACCESSORY RUCTURE � ADDITION ❑ PRIVY [Iy j' <br /> TYPE OF PERMIT(S): Ct <br /> FILLING/GRADING t❑ CAMPING UNIT El SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: ItbNTIAL AQtiE7 W o <br /> (Homabin; Commercial Business; Bedroom; Deck;etc.) U) <br /> BUILDING CONTRACTOR: JLuS <br /> m �1ti <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T 3 <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) N a <br /> c <br /> n 0 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. TIm v t z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> C � <br /> NORTH(N). c O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF B <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. I N <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. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: a <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Cj <br /> PERMITTED. r, <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUI /g7Wn�VATER V <br /> 5. <br /> SETBACK AREA. C� <br /> 6. mvaraoaom <br /> 7. c�A ✓ NCS NO_ <br /> /- V N <br /> m <br /> I declare that this application (including any accompanying schedule) has been examin and to th of my (j A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for �I and accuracy d �_ c <br /> all information contained in this application(including any accompanying schedule)and I furtha18rre In' OL <br /> ` M <br /> that this information I am providingelied upon by the County of Burnett Wisconsin in detPf / Ilt0 O <br /> sue a permit. I further accept all li lity wh1 may be a result of the County of Burnett relying on this I ormatl{I I am <br /> providing in this application. I ag ee to per t county officials charged with administering county ordinances or other <br /> authorized persoction. <br /> ave access the abo described premises at any reasonable time for the purpose of inspem <br /> m ' <br /> ID <br /> SIGN HERE i y- N- o 1 v, <br /> ( gnature owner or buildin otractor) (date) <br /> ZONING ADMINISTRA <br /> �) ai <br /> O UNSHIP PERMITS MAY BE REQUIRED tO UI q <br /> � CJ <br /> d <br />