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47?C4�yIa <br /> Burkett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator00 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> o <br /> N <br /> / <br /> _ � <br /> C �\ <br /> d <br /> OWNER I0jtVjZ 'z TELEPHONE 8� 0 <br /> I 9t <br /> HOME ADDRESS Omnge S Lk 2A �AS 0 <br /> v <br /> EMERGENCY/FIRE NUMBER ROAD NAME,/�y� t 1 <br /> p <br /> LEGAL DESCRIPTION(see tax receipt)/!�� j-r 1l� �t/ ��� c��O �� <br /> DWELLING/BUILDING GARAGE/ACCESSORRY/STRUrTTURE ❑ ADDITION ❑ PRIVY ❑ m o <br /> TYPE OF PERMIT(S): O C <br /> FILLING/GRADIN4M.- <br /> CAMPING UNIT ❑ SUBDIVISION Eln <br /> N <br /> STRUCTURE/ADDITION USE: 6 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: Ls�L <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> -n o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE EF <br /> NORTH(N). y <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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. { P <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO 1 <br /> BUILDINGS,ROADS,LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. M <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. So <br /> 0 9 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Ct <br /> 0 <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 f I 1 <br /> ISSUANCE. D <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <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 /> 6. m C m m O 3 Z <br /> 7. o y �� 01 <br /> _CO; i i M <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of a B <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize m m <br /> that this information I am providing will be relied u/ba <br /> y the County of Burnett Wisconsin in determining whether to is- O <br /> sue a permit. I further ac pt all liabi' hich maresult of the County of Burnett relying on this information I amprovidin in this applica on. I agr a to p rmit coofficial charged with administering county ordinances or otherauthori d p on to access t the ab a des re Ises at any reasonable time for the purpose of inspection. m <br /> m : <br /> m : <br /> cn ; <br /> SIGN HERE <br /> (signs ure of ne r4ifillding contractor) (date) <br /> ZONING ADMINISTRATOR <br /> W fA di ER fA fA� <br /> N N(nNN (n fn <br /> Vl (T O(T U1 O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED c <br /> 0000000 <br />