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BuFnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administ�o�r� � 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> �. � <br /> W <br /> C <br /> OWNER � \/�, � � ! .. ��� � •P / TELEPHONE 7i�- S6� ��„?� o <br /> / m <br /> HOME ADDRESS a � /' . v ,! ` J�� /, � ;° O_�,\\ <br /> EMERGENCY/FIRE NUMBER � � ROAD NAME J �-• ` � � r, l <br /> ��� � �� Tc.s �-�o- .� W � <br /> LEGAL DESCRIPTION(see tax receipt) ur <br /> m <br /> ° <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ O <br /> TYPE OF PERMIT(S): � <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> 7 "� 1,,, <br /> STRUCTURE/ADDITION USE:_� �� J x (..! o' ` 'n' <br /> (Home/Cabin; mmercial Business; Bedroom; Deck;etc.) y <br /> m <br /> BUILDING CONTRACTOR: <br /> � � <br /> v <br /> PLOT PLAN MUST BE PROVIDED ON AT LEAST AN SY:X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> � � <br /> DIRECTIONS FOR PLOT PLAN DRAWING• (AERIAL OR TOP VIE O m O <br /> � a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m :° <br /> NORTH(N). C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDINGS)TO ALL LOT LINES,(B)BUILDINGS)TO m \v <br /> CENTERLINE OF ROAD,(C)BUILDINGS)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF � Z <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. I � <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 � �, � � <br /> MUST BE SIGNED AND DATED BY THE OWNER. ° <br /> �y� O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN d � °, <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: `,'' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT q <br /> ISSUANCE. � <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. � � I'� <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 AR`EjAy.� <br /> 5. � Sr' / <br /> � V n� � 0�O � <br /> 6. � � 3 am ��' � A <br /> 7. � ' mcN !" c � 3 <br /> z �^ � ° � '10 =1 <br /> o ? �'� ( � <br /> =N: m <br /> 1 declare that this application (mcludmg any accompanying schedule) has been examined by me and to the best of my � �j c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accurac of � m ° � � 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- � � p <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 �� y <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other � <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> ° . <br /> p�� _ m <br /> SIGN HERE //Ir/Yv�-t � t`//�,r � lam+/f dws-std r o ` "' <br /> signature of ow r r b tilling contractor) �`�� J (�te) � <br /> l� <br /> ZONING ADMINISTRATOR <br /> to wcn(n tnw <br /> N NITNNUt <br /> � VtONNO <br /> TOWN HIP PERMITS MAY BE REQUIRED o 0 0 0 0 o O <br />