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Burnt County 7410 Co. Rd. K, No. 102, Siren,WI 54872 kice4of Zoning Adminis ator - o o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> CD <br /> _ Cl <br /> OWNER ���, V �� i _ TELEPHONE S, ( Ai �Im� <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER �1�\�p [7 ROAD NAMED j <br /> LEGAL DESCRIPTION (see tax receipt)P e L S W 5 W L <br /> ( o <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ �' U> <br /> TYPE OF PERMIT(S): Cr <br /> a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> _ i ` tl) <br /> STRUCTURE/ADDITION USE: G teal,\o�, ri V 0 `\Y1 <br /> (Home/ brain; Co mercial BusLit <br /> siiness; Bedroom; Deck; ettc.)) wBUILDING CONTRACTOR: CAAL ( �" l �ad / S <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. <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 0 <br /> -n O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE rn <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m kz� <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. <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 1 1V <br /> MUST BE SIGNED AND DATED BY THE OWNER. o C <br /> Cr 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a —� <br /> NEEDED. <br /> Q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o LI <br /> CONDITIONS OF PERMIT: k— I <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. _ f <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY apt S, <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. r ) �pA <br /> V" m � � me <br /> 0 <br /> 6. .< ram Or <br /> o U' �� 3 <br /> 7. <br /> rn <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Gj 2 ID <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o O <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize o 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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 3 <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��ding,q on or) �/� (date) <br /> ZONING ADMINISTRATOR <br /> En vi vi E»Ea vi� <br /> N NCANNUI CT <br /> N C.npoCnpp <br /> TOW SHIP PERMITS MAY BE REQUIRED o 0 0 0 0 0 0 <br /> 0 0 0 0 0 0 0 <br />