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Bt-,tett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator M 0 0 <br /> APPLICATION FOR LAND USE PERMITS N 1- <br /> a <br /> OWNER L TELEPH NE <br /> m <br /> � 3 o <br /> r / f <br /> HOME ADDRESS <br /> ���/1n ROAD NAME <br /> EMERGENCY/FIRE NUMBER �l <br /> a <br /> LEGAL DESCRIPTION (see tax receipt) � / <br /> J" N o <br /> ❑ GARAGE/ACCESSORY STRUCTUR ADDITION ❑ PRIVYE1 o <br /> DWELLING/BUILDING Cr <br /> TYPE OF PERMIT(S): 1 0 <br /> FILLING/GRADING ❑ CAMPI UNIT ❑ SUBDIVISI ❑ <br /> STRUCTURE/ADDITION USE: <br /> D o <br /> (Home/Cabin, Commercial Busme Bedrm, ck etc) oO <br /> BUILDING CONTRACTOR: <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR TO 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> O m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T v z <br /> n m 30 <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 C o <br /> NORTH(N). m 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO <br /> m o <br /> LAKEESTREAM OR RIVER ANDBUILDING(S)MEASUREMENT <br /> EASUREMENT TO WETLAND HE ORDINARY HIGH WATER MARK(OHWM)OF o <br /> AREAS. k <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. N <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS <br /> � o <br /> MUST BE SIGNED AND DATED BY THE OWNER. o 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° <br /> NEEDED. <br /> Z <br /> 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: <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 /> SE BACK AR A. �, r L,r <br /> 5. 6C/L(JL� v c>M 0 my a O v <br /> This structure to be used as private residential ° 3 0.r, � a <br /> 6. garage/storage only. Not to be used for human ° C o 6 3 <br /> habitation. <br /> Z : <br /> 1 m <br /> �. . . <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ` n JD <br /> I and acuracy of <br /> knowledge and belief it is true,correct and complete. I acknowledge I am responsible for the detaihedule)and I further declare that Icrecognize N m <br /> all information contained in this application(i Y <br /> that this information I am viding will be r ied on y the ount Bu ett Wisconsin in determining whether to is- <br /> sue a permit I cep all Ii wh ch be resu of th Coun of Burnett relying on this information I am <br /> providing i is applic ion. I ag ee t pe i c in ici Is ch ged wi administering county ordinances or other <br /> authorized/person to h acc ss t the a des i re ises any r sonable time for the purpose of inspection. <br /> -a <br /> SIGN HERE ( ate) <br /> signatu of o 1 mg co tra , <br /> ZONING ADMINISTRATOR p q' <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />