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Bufnett County 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 /> OWNER ^ TELEPHONE n <br /> 2V o � Q0HOME ADDRESS <br /> L/7, <br /> RC <br /> O o m <br /> EMERGENCY/FIRE NUMBER �Q ROAD NAME k k(" ) Ad t <br /> LEGAL DESCRIPTION(see tax receipt) La� �� 1J— yu <br /> TT Cn <br /> o ` 0 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ <br /> TYPE OF PERMIT(S): C <br /> FILLING/GRADING ❑ CAMPING UNIT SUBDIVISION ❑ <br /> a <br /> -� ✓�l y: <br /> STRUCTURE/ADDITION USE: f o' <br /> (Home/Cabin; Comm tial Busi ss; Bedroom; Deck;etc.) y <br /> BUILDING CONTRACTOR: <br /> t/ g d <br /> fit - <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/2 X 17 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m 3 <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) <br /> C 'v <br /> O o. <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 rn <br /> NORTH(N). <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 1 p <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. , 1 Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO I o <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 ' d <br /> MUST BE SIGNED AND DATED BY THE OWNER. c I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONEWHEN <br /> NEEDED. a ° <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c .. <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT O <br /> ISSUANCE. ` 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. pO <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY (I <br /> PERMITTED. ` <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER p`I <br /> SETBACK AREA. �1 <br /> 5. •1-J / re <br /> 611/ J UIQ dim✓tel 01 I C,q� �/V, <br /> X � nr O O � <br /> 6. (�a r,e71 r'e4noved b / `loVv ill ) L L2S, 9O In I r'a`�' / �(J CC kk33 //�� N <br /> 7. 112cy P�►'mit �1/) nePcf 5e6!1_) � f3✓ ���'!`� o " �� <br /> _ �. <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my �: 'Cr m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m C" : C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize O 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- G) 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 pp�' <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other y m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> - <br /> SIGN HERE r <br /> ( gnatu of owner o II g contractor) (date) <br /> ZONING ADMINISTRATOR ? E <br /> �riL"NN0Cn <br /> N NU� NN (J1(T <br /> (rl U1 O fn V1 O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 0 0 0 <br />