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Burnet,County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> - r <br /> y O \_ <br /> N M <br /> OWNER <br /> d w <br /> i VL2LC -� <br /> HOMEADDRESS "'f m � 0 <br /> �j o m <br /> EMERGENCY/FIRE NUMBER /s� ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ m 0 <br /> TYPE OF PERMIT(S): M c� <br /> FILLING/GRADING El CAMPING UNIT ElSUBDIVISIO S. <br /> S. <br /> STRUCTURE/ADDITION USE: l � / J 1 � Ile <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) y <br /> BUILDING CONTRACTOR: lir1 <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> , y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 p a <br /> m Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C1 m Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m :? <br /> NORTH(N). <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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. o <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. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. c <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> N <br /> O <br /> NEEDED. C QQ�� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z I R <br /> CONDITIONS OF PERMIT: c <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 /> 5. <br /> ;a -00) o L <br /> 6. a Uk <br /> Z' : ecsw �egr- <br /> 7. 0 `" COD <br /> o . <br /> _ur : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c 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 I 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- 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 above described premises at any reasonable time for the purpose of inspection. m <br /> CD : <br /> CD : <br /> SIGN HERE `A <br /> (signf owner or building con c r) (date) <br /> ZONING ADMINISTRATOR <br /> v+(A fA fA to fA <br /> N O I N N u 1(T <br /> N O P On OO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 00 0 0 0 0 0 <br />