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Bodrnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator, CDo 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> = r <br /> VT 5 <br /> 41 <br /> CD <br /> C <br /> OWNER TELEPHONE <br /> S <br /> HOME ADDRESS CNI SID SX) <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> ) <br /> C��� Pw� s �, <br /> LEGAL DESCRIPTION (see tax receipt) oa <br /> 1 fort � '� a(� N 4o t \ �U <br /> f _)_ m <br /> TYPE OF PERMIT(S): DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION PRIVY ❑ d c S' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ �`n <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Cabin; CommercialBusiness; Bedroom; Deck; etc.) rn <br /> BUILDING CONTRACTOR: <br /> m I <br /> � I <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8Ya X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> O <br /> A m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> -n o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Tt7m ? <br /> A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C n <br /> 3. SHOW DIMENSIONS 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 n <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 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. Q <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS W <br /> MUST BE SIGNED AND DATED BY THE OWNER. !1 <br /> F 7�+ <br /> O 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: Q <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 n , <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. l � nU <br /> md iu> oao -0u <br /> c�ill ,a f �e � o <br /> AI declare that this application (Including any accompanying schedule) has been examined by me and to the best of my , <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of \ 0 m <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m ' O <br /> sue a permit. I further accept all liabili h may be a result of the County of Burnett relying on this information 1 am <br /> m . <br /> providing in this application. I e to per It co <br /> officials arged with administering county ordinances or other <br /> authorized person to have o t ov cr' e s at any reasonable time for the purpo is of' pection. `D <br /> m <br /> ID <br /> SIGN HERE /3 �^ <br /> si tur of owe c Ilding co ctor) <br /> (date) <br /> a: <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> O <br />