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BU,Ynett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r/ 3 - d3 <br /> OWNER � T TELEPHONE,/� f <br /> m <br /> HOME ADDRESS <br /> i r � <br /> 0 <br /> EMERGENCY/FIRE NUMBER "ROAD NAME ' �� c <br /> I <br /> LEGAL DESCRIPTION(see tax receipt) R Wly !'C. k CWIAO I. <br /> w ^_ <br /> DWELLING/BUILDING 1:1 GARAGE/ACCESSORY STRUCTURE 1:1 ADDITION PRIVY 1:1O (p O <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING 1:1CAMPIN UNIT SUB IVISION ❑ <br /> N <br /> STRUCTURE/ADDITION USE: <br /> nJ�n' (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) C ~ <br /> BUILDING CONTRACTOR: _ 7��3 C lLo / <br /> J ,!/ /� m <br /> m <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR U -n <br /> g <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 33 <br /> O <br /> y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n Q <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> C o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m B <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. 1 0 <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. 043 N AL) <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS t 0. <br /> MUST BE SIGNED AND DATED BY THE OWNER. f l <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN ° <br /> NEEDED. 0 Q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 0 0 <br /> CONDITIONS OF PERMIT: W <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PE <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHO NE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICA <br /> PERMITTED. // 1 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE RE IRED'C'I <br /> 6 SETBACK AREA. /� Q�� O CQQ, <br /> % C <br /> Z : N N OID <br /> O 1p <br /> 7. 0 m <br /> - cn : <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize �) <br /> PP ( 9 Y ) 9 m m p <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 (D <br /> authorized person to have access to the above described premises at any reasonable time for th urpose of inspection. T m <br /> CD <br /> CD <br /> SIGN HER _d-0 .0 <br /> (sig of o er or building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> c <br /> TOWNSHIP PERMITS MAY BE REQUIRED Cj <br />