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d1 c�-� <br /> B4rnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m c o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> UT <br /> H 1^ <br /> C V` <br /> OWNER TELEPHONE rn <br /> m � <br /> HOME ADDRESS Box "�6 7 —,4eejy 7 5vyo v <br /> r- m <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) — — / /V�S �S�s <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ y 0 <br /> TYPE OF PERMIT(S): v ' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION <br /> STRUCTURE/ADDITION USE: �J// ) r�i6 d os CSIs Ui6ewr47 <br /> (Home/Cabin; Cc Mmeercial Business; Bedroom; Deck;etc.) co <br /> BUILDING CONTRACTOR: , ( / f[1 �V L � fir <br /> v <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 /> ZI N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o. <br /> I o 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(N). y ` 0 <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 <br /> BUILDINGS,ROADS,LAKE, LOT LINES. `rZu <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. i; <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. c <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN a <br /> NEEDED. <br /> I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: (U <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. 1 9j <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER —9 <br /> SETBACK AREA. 1 <br /> 5. U' <br /> m said MOM, <br /> 6. 3Cino �� <br /> O N N O =(a <br /> 7. <br /> v,: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c C� <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m mom, <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- \ f '• 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. 'n <br /> C9 <br /> m : <br /> 40 : <br /> SIGN HERE <br /> (signature of o ner or building cont ctor) (date) <br /> ZONING ADMINISTRATOR <br /> tnt»tnwtnanCA <br /> N N 01 N N Vt N <br /> 01 010 Cn 0100 <br /> TO NSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br /> 0000000 <br />