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z2 <br /> Bur lett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> OWNER y� n w <br /> L7laV Jn TELEPHONE7/ 63s'-So Soo <br /> HOME ADDRESS <br /> T o m <br /> EMERGENCY/FIRE NUMBER 1 RO ]l� 1 tl�� <br /> LEGAL DESCRIPTION(see tax receipt) �L1�� /��/� <br /> V y <br /> Q <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ q o <br /> TYPE OF PERMIT(S): � 0 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: m <br /> o' <br /> (Home/Clabin, Commercial Busines , Bedroom; Deck;etc.) y <br /> BUILDING CONTRACTOR: <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. _r <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING• (AERIAL OR TOP VIEW) 0 m Q <br /> In O o. <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T F5 0 Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m \ A <br /> NORTH(N). C Vl O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m `� <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF v <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 1 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. 'V <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 ' 03 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> 31 <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 <br /> CONDITIONS OF PERMIT: P <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I <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 n <br /> SETBACK AREA. / " 1 <br /> 5. L /J/'/ <br /> ;u -V n r� 00 V <br /> 6. 3 C m <br /> C') 9 a m x e= M <br /> 'am C:0, 0, <br /> 7. Z Co X01 <br /> oM <br /> — v,: E <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �j ff 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 any accompanying schedule)and I further declare that I recognize 6 m m i i M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m p <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 /> m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other tI� CD <br /> person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> m <br /> CD <br /> SIGN HERE yr i <br /> (signatur ownerorbuildi c recto (date) <br /> ZONING ADMINISTRATOR <br /> v+tn cn v.cnw r' <br /> N N(TNN V1 (T <br /> cT �nocTcnoo <br /> OWNSHIP PERMITS MAY BE REQUIRED Z 0000000 <br /> 0000000 <br />