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BUrwett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator ' o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> OWNER �s��/ % L TELEPHONE—;7/S — <br /> O <br /> HOME ADDRESS/9,q`7 �Z) <br /> (^ 0 <br /> EMERGENCY/FIRE NUMBER .,CJ ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) ,6- LI <br /> /p1 d / !J. 41 Af LQ� 3 I Cn <br /> S-! O m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING IN CAMPING UNIT ❑ SUBDIVISION 5 <br /> f�x l g 5 �- <br /> STRUCTURE/ADDITION USE: ��l.,� d c- 0 <br /> /� <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) m <br /> BUILDING CONTRACTOR:&/Ya /L lnolJe <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR •n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) c <br /> in a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m d 'o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m \ v <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. ° <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. t ii <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS33 <br /> ?, <br /> MUST BE SIGNED AND DATED BY THE OWNER. v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN ryry Cr <br /> NEEDED. V <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> d <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT j Q <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. YJ <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. 075 ^ 6� <br /> X = m m 6 m <br /> D, A <br /> L <br /> 6. mc0 <br /> Z <br /> co <br /> A <br /> 7. o : <br /> -N: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my $R c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of CL <br /> W <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize JW: i m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 00 l7 <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 O <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 thejabove described premises at any reasonable time for the purpose of inspection. n :6i <br /> m : <br /> CD :4 <br /> SIGN HERE, <br /> (Signlatvhi1 o-f owner or building ntractor) (date) <br /> ZONING ADMINISTRATOR ? <br /> N VINNN <br /> UtOfT N O , <br /> TOWNSHIP PERMITS MAY BE REQUIRED -00o 0 o 0 0 <br /> 0000 <br />