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Burnettgounty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> m 0 <br /> �� y <br /> OWNER � TELEPHONE <br /> n y <br /> HOMEADDRESS h / „�fyellliv <br /> r m <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME .. <br /> LEGAL DESCRIPTION(see tax receipt) Ll —1,6 C <br /> co <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY 0o) o <br /> TYPE OF PERMIT(S): a <br /> 0- <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION a <br /> 5. <br /> ism 7�-%/ 0 <br /> STRUCTURE/ADDITION USE: / o' <br /> (Home/Cabin; C-o'mme"racial Business; Bedroom; Deck;etc.) � <br /> BUILDING CONTRACTOR: v` '/YT.G� �](iCy/ P�(� //l�— Er <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8Y:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 'n c <br /> O — <br /> Tf N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O G <br /> n n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> Z-n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <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 3 <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. Z0 <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. D <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. o ) <br /> o ,C. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN 0 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z -47— <br /> CONDITIONS OF PERMIT: <br /> 0 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 91) <br /> ISSUANCE. 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. p <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY r <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER C <br /> SETBACK AREA. <br /> 5. <br /> qq <br /> 7. Z : w MW f° 1 <br /> O <br /> — rn : <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c m m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofm c <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize m m : M <br /> PP ( 9 Y ) g <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is— <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am y <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 /> m : <br /> CD : <br /> SIGN HERE fn ` <br /> (sign atur of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR t <br /> fn to to to v+fn <br /> N N f 11 N N N N <br /> fT Vt O V7 N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />