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atlrnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator � o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> F <br /> C <br /> d <br /> OWNER �, ' f ( � rr1 � �Y TELEPHONE <br /> m <br /> �]J- 1 cX) <br /> HOMEADDRESS '�Q 8C))( ` to Dn_0btkrq � � u <br /> r � <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME R <br /> LEGAL DESCRIPTION (see tax receipt) G — ! f:�?— q©—J6 I <br /> � r– <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ c �✓ <br /> TYPE OF PERMIT(S): 1�X1ICr <br /> FILLING/GRADING El CAMPING UNIT ❑ SUBDIVISION y�L a ^- <br /> STRUCTURE/ADDITION USE: l I Yl ��Q �� 3 n ` <br /> !('Home/Cabin;Commercial Business; Bedroom;Deck;etc.) V ALJ <br /> 2. <br /> BUILDING CONTRACTOR: fit <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 H .^^� _y <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) J <br /> O o. <br /> 'n o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m a <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C <br /> NORTH(N). o <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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO 0 <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 2, <br /> MUST BE SIGNED AND DATED BY THE OWNER. 00 0 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED. <br /> .J <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. P <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT {1 C <br /> ISSUANCE. `Oy <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. (f 1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY c <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> m = m'rm0 a 9m <br /> 6. a • myoNo1O =j <br /> 7. C <br /> -_ Cl): m <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 16 <br /> C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of 0 2 <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 ; <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. T <br /> m <br /> m : <br /> to <br /> SIGN HERE <br /> (signs re of owner or buildin ntractor) (date) <br /> ZONING ADMINISTRATOR Fn v+w fn v+w <br /> (N7, NOfNJ� N00 <br /> 0 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />