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Mev' q <br /> BurrrL,tt Couuty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -V G) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r (V <br /> N o v J <br /> OWNER ' 1 / � TELEPHONE 7/S <br /> �►l/l {'��.Ot�f L Af/.G .S^(J/'G/C �'/ U�d r j _ M <br /> HOME ADDRESS 1 J\ <br /> 0 <br /> EMERGENCY/FIRE NUMBER IX 9 ROAD NAME <br /> LEGAL DESCRIPTION see tax receipt) Cn <br /> e <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ PRIVY ❑ c 0 <br /> TYPE OF PERMIT(S): — - <br /> o- <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION p❑ n <br /> STRUCTURE/ADDITION USE: POLE 8011-0/N6 rol V ICIRi Q M <br /> / [-D <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) rn � <br /> L . <br /> BUILDING CONTRACTOR: ESTex ul4lc^ lE SYS]�141S <br /> C <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/a X 11 SHEET OF PAPER. ANY INCOMPLETE OR - <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m X <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). <br /> 0 <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 <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 0 �p <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> ° f <br /> O � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o <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 SHORELINEF <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALy Iy <br /> PERMITTED. " ,'`7 i — A <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 6. m 3 a m � ° m M <br /> ' "O N C y 0 <br /> 7. 1 Z : y y 0 (p <br /> O 1� <br /> =2 AI declare that this application (including any accompanying schedule) has been examined by me and to the best of my \ c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of , o <br /> W ` . <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m � � <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- �j <br /> sue a permit. I further taftitabiti ch may be a result of the County of Burnett relying on this information I am <br /> providing in thi plication. I agree to perm) unity officials ch ged with administering county ordinances or other <br /> authorized pson to have access to the above desc 'bed premises ny reasonable time for the purpose of inspection. m <br /> m <br /> CD <br /> SIGN HERE __ A�L�. 7 , a00 <br /> ( n ure of owner or building cont (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />