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B6rnett County 7410 Co. Rd. K, No. '102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> u <br /> OWNERLJO h tr\ `I o n TELEPHONE <br /> m <br /> HOME ADDRESS 13(SSS/V ,'Tn 1 Yi "('QJDX 447 //14401-n A774) 5S0V3 o Oe <br /> EMERGENCY/FIRE NUMBER ROAD NAME E- ���j �✓ 1 ~ <br /> LEGAL DESCRIPTION (see tax receipt) �Q / Q/�[L � ��„Q, M t <br /> I o <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ PRIVY ❑ cn � <br /> TYPE OF PERMIT(S): CL <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ S <br /> STRUCTURE/ADDITION USE: it I I lX( <br /> (Home/Cabin; mercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: � <br /> v <br /> M <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 y <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) Oo. <br /> T <br /> I o - Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE rn n <br /> NORTH(N). U) <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS � d <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q <br /> NEEDED. (� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ? � <br /> CONDITIONS OF PERMIT: <br /> Q <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 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. A 'a 0r o�oV <br /> N ° A d m <br /> 6. vSm xa.— ;u <br /> ' NnmoN � � 3 <br /> Z : <br /> 7. c ' y <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 1 am responsible for the detail and accuracy of o <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize C^ m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to is- m 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 m <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. - <br /> CD <br /> m : <br /> SIGN HERE <br /> (signature of o er or uilding contractor) ( ate) <br /> ZONING ADMINISTRATOR <br /> v+vrtnwcnvi <br /> N NNNNfTN <br /> �N N O N Ut O O <br /> O 0 00 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />