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Burned'County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator -U G) Z <br /> APPLICATION FOR LAND USE PERMITS <br /> ' r <br /> y <br /> OWNER DO <br /> I C <br /> LA—i �! �, TELEPHONE �'s/_ �/ CL <br /> 0 <br /> HOME ADDRESS VL.UL� V j �� IV© - Og��a✓ MIN, <br /> EMERGENCY/FIRE NUMBER ° <br /> ,�'7 ROAD NAME <br /> � • .tel <br /> LEGAL DESCRIPTION(see tax receipt) T a© © co <br /> ,✓ `f 9 (v 3 co <br /> CD <br /> TYPE OF PERMIT(S): DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION PRIVY ❑ <br /> cn <br /> o' <br /> C � <br /> FILLING/GRADING E CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: �/QCjq,7 /eppyy) yyif`( �yyt S��•�4/2 0: <br /> (Home/Cabin, Commercial Business; Bedroom; Deck; etc.) <br /> p _ cn <br /> BUILDING CONTRACTOR: <br /> m <br /> Z � <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) A <br /> O m <br /> o- - <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. TTty I Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m o XJ <br /> NORTH(N). C v <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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO ' o <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 1O <br /> MUST BE SIGNED AND DATED BY THE OWNER. �. o <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. Z O <br /> CONDITIONS OF PERMIT: O <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 V <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. ;a -U 0r. > 0 > <br /> m m o m a O � <br /> f m <br /> 0 < n <br /> 7. - N C y N <br /> Z m 0. 0 t0 <br /> O : i142 .ZI <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 1 !T A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d C c <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- <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to h ccess to the above described premise at any reasonable time for the purpose of inspection. mD <br /> : <br /> m : <br /> SIGN HERE a g � <br /> (sig re o wner or ildin c tra r) date <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />