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Bfirneft County 7410 Co. Rd. K, No. 102, Siren,WI 64872 Office of Zoning Administrator 'o c) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> F O <br /> CD <br /> OWNERC <br /> TELEPHONE <br /> CD�/ m Ft <br /> HOME ADDRESS S7 7 /� _ / eek �j �� 0 <br /> ' l �L r m <br /> EMERGENCY/FIRE NUMBER ROAD NAME � <br /> / 3LEGAL DESCRIPTION (see tax receipt) <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ c M <br /> TYPE OF PERMIT(S): � <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISIONA I 5 <br /> STRUCTURE/ADDITION USE: GS m Ve ZI 10 13-3-- 13L/ <br /> (Home/Cabin; Commercia Bus'sinf ss; Bedroom;Deck;etc.) <br /> BUILDING CONTRACTOR: ��eI�S ��'Z( 7 �LC-{�y� 7' CD_ <br /> v <br /> 1 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> O — \ <br /> M y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n G <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m M <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE mAa <br /> NORTH(N). <br /> n <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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. o <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. c <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN " 0 <br /> C <br /> NEEDED. r <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o p <br /> CONDITIONS OF PERMIT: rN <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT (n/ <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 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> ;a V C) r0�0 V <br /> • as ( n m <br /> Z M07. o <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c p <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize V: m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- O <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. -n <br /> m : <br /> m <br /> SIGN HERE <br /> (signature o wner or building contra tor) (date) <br /> ZONING ADMINISTRATORQl�L/� ©2 <br /> bn <br /> F»fn rn <br /> N N 01 En <br /> N N (nfn <br /> V1 U1 O U1 (Jf O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />