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Bt:.^nett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> CAb <br /> OWNER R��✓� Ah2c ee TELEPHONE Grl, y.26'6616 v <br /> W <br /> HOME ADDRESS rg�`� cLeerice &Qor Afte AAA 5-5-1/ 0 <br /> m <br /> EMERGENCY/FIRE NUMBER �:2yo'. ROWOAD NAME ° <br /> LEGAL DESCRIPTION (see tax receipt) p — 3 C CJ� -U <br /> 1� <br /> DWELLING/BUILDING 1:1GARAGE/ACCESSORY STRUCTURE X ADDITION ❑ PRIVY ❑ °_ <br /> TYPE OF PERMIT(S): <br /> v <br /> FILLING/GRRAD�ING,,❑ CAMPING UNIT ❑ SUBDIVISION <br /> l ❑ <br /> STRUCTURE/ADDITION USE: M& <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: (� <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/z X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m W <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> CD <br /> NORTH(N). C ° <br /> m <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO 13 <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. ° r\I <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 4 <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 /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN T ° <br /> NEEDED. vi <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o V <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 SHORELIN .i'J <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY d l V <br /> jr <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUI ATERa JIG <br /> SETBACK AREA. a <br /> s. SURNE�COU ( a n 0 o aOX � m <br /> 6. ZONING N N � 0N �� 3 <br /> �. o (D z <br /> _ Cn : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize mCD <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 0 <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 have access to the above described premises at any reasonable time for the purpose of inspection. T <br /> m <br /> CD : <br /> SIGN HERE <br /> 3l- 0 / <br /> (si n of owwnnferr�or building contractor) / (date) <br /> ZONING ADMINISTRATOR �m f /(3!/�/�✓) <br /> TOWNSHIP PERMITS MAY BE REQUIRED O? <br /> I <br />