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Burysiett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 ° <br /> r <br /> N 0 <br /> N <br /> C <br /> Q <br /> OWNER 6 f , f TELEPHONE <br /> HOME ADDRESS P, CEJ r / V �/yl, f� { p <br /> ^-�cF� LI CLO r m <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) A <br /> TYPE OF PERMIT(S): <br /> ��pprr�� <br /> DWELLING/BUILDING 9 GARAGE/ACCESSORY STRUCTURE 1:1ADDITION ❑ PRIVY ElI y 0 <br /> `t� or <br /> o <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ ��'y) a <br /> STRUCTURE/ADDITION USE: 14p'K1 7-, fe, 0 <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) Cn V\ <br /> BUILDING CONTRACTOR: or <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n <br /> O <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T <br /> o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m fir <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 <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 ti <br /> BUILDINGS,ROADS,LAKE, LOT LINES. _ <br /> S. 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 i ' �) <br /> MUST BE SIGNED AND DATED BY THE OWNER. •Q c <br /> Citi o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHENq <br /> NEEDED. Cr �/1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c ( nj <br /> CONDITIONS OF PERMIT: <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. 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 /> A = 3 ' Ib m L <br /> p <br /> 6. y O m 7 0' <br /> 7. Z : rn � � <br /> O A <br /> - rn : E m <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my c p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m 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 /> d <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 d <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 �? <br /> m : <br /> SIGN HERE � d' <br /> (sign re of ovAer or buil ng contract r) (date <br /> ZONING ADMINISTRATOR IZZ . . . . <br /> N N N N N Cn <br /> N (TP CT CT OO P <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />