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Burnett,County 7410 Co. Rd. K, No. 102, Siren,W154872 Office of Zoning Atifhihistratoor�v c) Z <br /> APPLICATION FOR LAND USE PERMITS 3• <br /> y O <br /> c <br /> OWNER d TELEPHONE 7 Q <br /> Lf��(�D cJ l �c <br /> HOME ADDRESS 77,,- L r U //�J <br /> EMERGENCY/FIRE NUMBER7 -7 7 3 ROAD NAME U d ��kP ) r • GQ <br /> PGLEGAL DESCRIPTION (see tax receipt) r � �� �3— / //—a� I C') <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ y 0 <br /> TYPE OF PERMIT(S): <br /> o- <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION ❑ o, <br /> N' <br /> STRUCTURE/ADDITION USE: Cg f-.A-y `tom o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) w <br /> m <br /> BUILDING CONTRACTOR: <br /> tu' <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR M <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n - <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING, (AERIAL OR TOP VIEW) p Q <br /> 11 a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 9 <br /> NORTH(N). C 0 <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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO I <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. c <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN Cr o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: ° i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. GGG_ <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 /> 5. <br /> 6. m w ° m <br /> 7. m C N M <br /> M 0 ° <br /> ° : i =MC at <br /> =Cr [ m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my a5c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m E. C <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize m m m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- p <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 to <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> SIGN HERE _ d' <br /> (signatur of ow r or building contractor) '(date) <br /> ZONING ADMINISTRATOR <br /> w fn v+�n Fn w-• <br /> N N (liNNt7N <br /> TOWNSHIP PERMITS MAY BE REQUIRED �0 0 0 0 0 0 0 <br />