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OW- 77cr <br /> Bwnett"ounty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> , APPLICATION FOR LAND USE PERMITS 3. <br /> ,✓g E/zm l-r L,¢e <br /> OWNER � PHONE <br /> N/ �^'// <br /> HOME ADDRESS/C�O� J Y�UD/(/��� Y� <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> 1 <br /> LEGAL DESCRIPTION(see tax receipt)��0 � 9 ����� Z®T 3 0 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ Cl) <br /> TYPE OF PERMIT(S): c <br /> FILLING/G DING ❑ CAMPING UNIT �l SUBDIVISION El <br /> STRUCTURE/ADDITION USE:�� <br /> (Home/Cabin; Commercial Business; Bedroom;Deck; etc.) U C <br /> BUILDING CONTRACTOR: / <br /> i/l� li � cr� SCD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/]X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> M N / <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) C W <br /> O o. <br /> In <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m A p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m cvy <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. P <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. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS J <br /> MUST BE SIGNED AND DATED BY THE OWNER. c <br /> O 1 <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. o <br /> CONDITIONS OF PERMIT: o <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 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> m C m . o <br /> Z : N m� <br /> 7. o y : : M <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Lj 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 L' <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- O <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the abovfirdescribed premises a able time for the purpose of inspection. T <br /> SIGN HERE <br /> (signature of own ilding contractor) I i(date) <br /> ZONING ADMINISTRATOR ' <br /> Lj <br /> Fn fn t»to w w <br /> H (n PN N P9 <br /> Vt O V7 VI O O <br /> TOWNSHIP PERMITS MAY B�ZUCO(jl�TY 0 0 0 0 0 0 <br /> 000000 <br /> ZONING <br />