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Burnett Country 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 G) Z <br /> APPLICATION FOR LAND USE PERMITS 3 P <br /> N O0 <br /> fn <br /> W <br /> OWNER TELEPHONE <br /> HOME ADDRESS /07 �5�y C V led 6 — cY—u VCS LLY� J �f v <br /> r � <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME .. <br /> LEGAL DESCRIPTION(see tax receipt) �;Z4 ,0 ,�?- CsSM (/ ~� - / -`3 m <br /> m <br /> DWELLING/BUILDING ❑ ❑ <br /> GARAGE/ACCESSORY STRUCTUREEl ADDITION ❑ PRIVY � y � <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRA RAD/ING ❑`CAMPING UNIT ❑/ SUBDIVISION 5. <br /> STRUCTURE/ADDITION USE: `- �/ 3 1 V' �W �a 8– oZ� 0 , <br /> (Home/ bin; Commercial Business* Bedroom; Deck;etc.) Cn (� <br /> ✓ m <br /> BUILDING CONTRACTOR: fS <br /> T <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR n3. <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> °0 N �V <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) -n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). N c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m ��) v <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. <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. 1, <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS V" <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> O � ( <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q S c� <br /> NEEDED. C A <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. rQr•- <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. W <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY p ) <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER ` <br /> SETBACK AREA. <br /> 5. <br /> C� n k <br /> (m1 -0 3 0 r. o. m <br /> 6. W G O N N _ <br /> 'O N C V1 0 <br /> Z : N <br /> 7. P : „ :0 <br /> =yE m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c IM:) <br /> and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m 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 w <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or othe m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> m <br /> m <br /> SIGN HERE '• <br /> (sigature of owner or buil n contractor) (date) <br /> ZONING ADMINISTRATOR <br /> �tntnwww(n01 <br /> (071 L"OINTI L"00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br /> �0000000 <br /> M <br />