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Burn_tt County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v c) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> 0 0 <br /> N <br /> OWNER TELEPHONE�pirLSCd- d <br /> -)(OS-;S1 <br /> p :? <br /> HOME ADDRESS &.�-7 Rd O rfQi t.�i <br /> r m <br /> 0 <br /> EMERGENCY/FIRE NUMBER JOS-7e, ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) �7 <br /> —/�J /�e P.lts Lo< Jo eck m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ® ADDITION El PRIVY ❑ 0a. i <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ S.N <br /> STRUCTURE/ADDITION USE: �+�`X 7� (� A ru52 C d <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) w <br /> m <br /> BUILDING CONTRACTOR: Et <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> -n 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 m IF <br /> c1 <br /> NORTH(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 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 S <br /> BUILDINGS,ROADS,LAKE,LOT LINES. <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. to <br /> o t <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q <br /> NEEDED. 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P I <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. <br /> 5. <br /> ;a -=V. o0i m m kov <br /> o m <br /> • m c,n . o 3 <br /> 7. Z '" m� � ° 1 <br /> o <br /> y: <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Z c C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m 0 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CD m <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 V �, <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 /> CD : <br /> SIGN HERE <br /> sign re o ne or building contr ct (date) <br /> ZONING ADMINISTRATOR U <br /> N N V1NNfl1 Vt <br /> Vt Vt O Vt u1 O O <br /> TOW P PERMITS MAY BE REQUIRED 0 0 0 0 0 <br /> 0 0 <br /> HI <br />