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Bwnfft'County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N <br /> N <br /> C r-- <br /> W �I� <br /> OWNER /-i if. i� / ./ TELEPHONE/� i n <br /> S�HOME ADDRESS � y � 2 �'� r , � ��' � � 0 <br /> / J <br /> EMERGENCY/FIRE NUMBER 9 "' V6 ROAD NAME ( .. <br /> q <br /> \J <br /> LEGAL DESCRIPTION (see tax receipt) V 1j }kob�� <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE El ADDITION ❑ PRIVY ❑ 8 (/)'') <br /> TYPE OF PERMIT(S): C d-1 <br /> Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5 <br /> 1� _ N <br /> STRUCTURE/ADDITION USE: LT✓._ ��� 0 <br /> (Home/Cabin; Corpmercial Business; Bedroom;Deck; etc.) m <br /> BUILDING CONTRACTOR: ( � Yt x_ is <br /> � m <br /> 17 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR CD <br /> 3 - <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 and <br /> ?� Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m i <br /> NORTH(N). N o <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 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 c �} <br /> BUILDINGS, ROADS,LAKE,LOT LINES. 4) <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N b <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 � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN a <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <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 /> SETBACK AREA. <br /> 5. <br /> A -0 n r- G O <br /> m �. m � ma m <br /> 7 <br /> 7. o m G i =1 <br /> cn <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my O c : i C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of c <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognizem m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- y l7 <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 d ; <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to hav ccess to the above descirligo premises at any reasonable time for the purpose of inspection. -n <br /> m : <br /> CD : <br /> SIGN HERE <br /> (signature of o er or Wilding contractor) (date) <br /> ZONING ADMINISTRATORlYl l(rAIXI l <br /> www w� <br /> N N Vt N N <br /> Vt V1 O 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 0 <br />