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Burnett,County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v Z <br /> APPLICATION FOR LAND USE PERMITS 3 ^ ° <br /> i <br /> o <br /> OWNER C 7 �. �; TELEPHONE% 7 I k <br /> c <br /> HOME ADDRESS /Z; r c1 TAS K <br /> (n <br /> Ir- m <br /> EMERGENCY/FIRE NUMBERO t/ ROAD <br /> SNAME ��c�/! <br /> LEGAL DESCRIPTION(see tax receipt) <br /> Cn <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ y o <br /> TYPE OF PERMIT($): c 0 <br /> FILLING/GRADING El CAMPING UNIT ❑ SUBDIVISION F-1a <br /> +� 5. <br /> STRUCTURE/ADDITION USE: KC/yj f�L r{ It1(!/ ,flc r 'k 3� ` o• <br /> (Home/Cabin, Commercial Business; Bedroom; Deck;etc.) y <br /> BUILDING CONTRACTOR: ) e l� <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. OT <br /> DIRECTIONS FOR PLOT PLAN DRAWING• (AERIAL OR TOP VIEW) M `� \ <br /> c <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T o Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). fir <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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. I 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. UPJ <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 1 O <br /> MUST BE SIGNED AND DATED BY THE OWNER. c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN Cr <br /> NEEDED. <br /> T <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: c <br /> I <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. I <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. rr 1111 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER 1Jv <br /> SETBACK AREA. <br /> 5. <br /> * < n a <br /> NO. ; <br /> 7. Z : a O O 10 <br /> o : itI <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my . :: p <br /> Cr : <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 'a° 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 <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other , <br /> as <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> SIGN HERE /fy'.`s'/� LI-23— / 7 � <br /> / (signature owger or building contr tor) (date) <br /> �•: <br /> ZONING ADMINISTRATOR <br /> fn fn.H w w Ln 01 <br /> P <br /> N N N N OI <br /> VI Vl O CT ut O O <br /> TfWNSHIP PERMITS MAY B REQUIRED 0 0 0 0 0 0 0 <br />