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G � <br /> BW11ett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 O o <br /> APPLICATION FOR LAND USE PERMITS 3. T <br /> s <br /> OWNER TELEPHONE 7 f15, <br /> HOME ADDRESS a y� J�/1�� In,� �I,I(J�2 � <br /> 0 <br /> ULL( VV �"(JJ J <br /> N 1 " <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> Sy517'W- .P/Gtv j8 pce--e5 <br /> LEGAL DESCRIPTION(see tax receipt) 422 _ yd 6 _ S —_�� 7X N <br /> CD <br /> T <br /> TYPE OF PERMIT(S): <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE JErADDITION 1:1PRIVY o' <br /> FILLING/GRADIN ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: D' <br /> o' (1 . <br /> (Honaff/Cabin; Commercial Business; Bedroom; Deck; etc.) Cn <br /> m <br /> BUILDING CONTRACTOR: <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR CD <br /> v3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> �l N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n CL� <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Z <br /> b <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE n o <br /> m <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF o <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 <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> 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 <br /> CONDITIONS OF PERMIT: 9 <br /> t <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT C>- <br /> ISSUANCE. <br /> riISSUANCE. q�i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. \ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY t <br /> PERMITTED. , <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE RE I �,7Et�� 6 <br /> SETBACK AREA. (-J � <br /> 5. <br /> This structure to be used as private residential r > p > 0 -0 <br /> s. garage/storage only. Not to be used for human �Uti " ` s a 0 � a " M <br /> 7. habitation. BUR 2 1�0/ N 0 o y g 3 <br /> IV -n� z <br /> I declare that this application (including any accompanying schedule) has been examined by mei q G) _- A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the iztil/�rl�accur�of m <br /> all information contained in this application(including any accompanying schedule)and I further declare tha I recognizeID <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to ze ' <br /> is- <br /> sue a permit. I further accept all liability which ma be a result of the County of Burnett relying on this information la m <br /> providing in this applicatio ee to p it coun officials charged with administering county ordinances or other <br /> authorized person to h acce t the ribed premises at any reasonable time for the purpose of inspection. m <br /> m <br /> CD <br /> SIGN HERE > —2 <br /> (s ure o ow r building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> � O <br />