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Burnett,County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - 0 <br /> APPLICATION FOR LAND USE PERMITS . <br /> VI <br /> C <br /> OWNER ^ TELEPHONE -1{5 3 m <br /> HOME ADDRESS 3 p <br /> EMERGENCY/FIRE NUMBER ROAD NAME �T m <br /> � a- <br /> 7,(d l - `� <br /> LEGAL DESCRIPTION (see tax receipt) ] Cn <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ Cn 0 i <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADINCAMPING UNIT ❑ SUBDIVISION ❑ <br /> H <br /> STRUCTURE/ADDITION USE: O Mn Ei -(l. <br /> (Home/Cabin; Co menial Business; Be room; Deck;etc.) m <br /> BUILDING CONTRACTOR: f I; <br /> T <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 00 m b <br /> n a <br /> T Z <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 n <br /> NORTH 3. SHOW D M)ENSIONS 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. P <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 'c o <br /> o � � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> z <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 /> SETBACKAREA. .Fri^ 4yL// /1 / <br /> 6. m.� 3 nrn 0 <br /> R c N " o S 3 <br /> Z : <br /> 7. f �r OSev^ t�,l, <br /> y CDA <br /> = c'; m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my .L7 c C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of {Y�' o Et <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 1I�1: CD m m <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. I further accept all liability which may be a result of the County of Burnett relying on this information I am m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other Co <br /> authorized persog tqj havpqccess to the abov esri d premises at any reasonable time for the purpose of inspection. <br /> (D : <br /> m : <br /> SIGN HER'44 <br /> i aturef owner r n ontractor) (date) <br /> ZONING ADMINISTRAT R <br /> N N N N f n <br /> O <br /> (lO (Jf fT O O <br /> O O O O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED c <br />