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Burrett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator) i - o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> n 0 ^ <br /> oVV\ <br /> N <br /> N <br /> OWNER L TELEPHONE <br /> HOME ADDRESS <br /> 6/_()( ) U U �q:q r <br /> 1 <br /> o <br /> EMERGENCY/FIRE NUMBER ROAD NAME n> <br /> LEGAL DESCRIPTIONt see tax recei <br /> ( p) jUJ u o (4-, L)n l GI T Ets/U IWOCn <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ c <br /> TYPE OF PERMIT(S): <br /> cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5 <br /> STRUCTURE/ADDITION USE: / l /� � 0 <br /> (Home/Cabin; Commercial Business; Bedroom; D ;etc.) rn h <br /> m <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 v <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 w <br /> O — <br /> :0 N d <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> T CL <br /> TI Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). W G <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 Z <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. <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. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o Ll✓ <br /> � I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT r <br /> ISSUANCE. r� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. w <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 /> iXim <br /> 6. COD <br /> C m o 3 <br /> 0 <br /> 7. ' y =?I � ;a <br /> o <br /> (':' - rn : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ��1f 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 o it <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- '(� ; obi 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 J m <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 /> m : <br /> SIGN HERE `i �S <br /> (signature o o r or building contractor) (date) <br /> ZONING ADMINISTRATOR Zn • • • • • . Fn <br /> fn v+v+v+v+cn <br /> N NtnNNfn ut <br /> �, Ut U7OUi�o O <br /> T /NSH'IP PERMITS MAY BE REQUI D o <br /> 0000000 <br />