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Burnett Cbunty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> H <br /> / d <br /> OWNER TELEPHONECD <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER .71 ROAD NAME 1 <br /> LEGAL DESCRIPTION(see tax receipt) LI-7 �p�( � <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE,C`J ADDITION ❑ PRIVY ❑ rn <br /> TYPE OF PERMIT(S): <br /> Q <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION ❑ q <br /> S. <br /> N <br /> STRUCTURE/ADDITION USE: o' <br /> me/Cabi Commercial Business; Bedroo ; Deck;etc.) cn <br /> a <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> ,n w <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m I jp <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TOm v 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. <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. `2 O <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. S oJqj <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° (h <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT �1 <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY O '(, S <br /> PERMITTED. r1 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. // , <br /> zvnr-�vov <br /> <. m m <br /> 6. 3 L34 <br /> D0M q <br /> 7. mca, o � 3 <br /> o : <br /> l_ W : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c : C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy ofn 0 <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- <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other (o <br /> authorized person to have acc ss to the abo a described premises at any reasonable time for the purpose of inspection. -n <br /> m : <br /> m : <br /> SIGN HERE d G Q <br /> nature o nero building contra or (d te) <br /> I <br /> ZONING ADMINISTRATOR 1 <br /> N NOS NN <br /> o PCn <br /> (T Vt fn [n o 0 <br /> TO NSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />