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Buris"t County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v C) Z <br /> APPLICATION FOR LAND USE PERMITS 3 Pt <br /> r y � <br /> N O V <br /> OWNER T ►y' j � el? TELEPHONE g6� -92-37 <br /> o <br /> HOME ADDRESS / �Q 1f_ F y-r ED5// y" r/1 /Y C� 5-! lZ v <br /> EMERGENCY/FIRE NUMBER 3� ROAD NAME Y_Al Z 4?4 AICE412- <br /> LEGAL DESCRIPTION(see tax receipt) Q m <br /> r� <br /> TYPE OF PERMIT(S): DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE L'J ADDITION ❑ PRIVY ( aC]��'� <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SU—BSD—IyVIISION ❑ 5{ <br /> STRUCTURE/ADDITION USE: (Xoj AAA E Fes( / '� or <br /> (Home/Cabin; Commer Iacl Business; Bedroom; Deck; etc.) U) G <br /> m <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> �I N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m Q <br /> n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m ;? <br /> NORTH(N). C c <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. P <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. �y <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. rf <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. 5. � <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN w o <br /> NEEDED. n <br /> This structure to be used as private residential <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BE garage/storage only. Not to be used for human o <br /> CONDITIONS OF PERMIT: habitation. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. l T <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Q <br /> PERMITTED. n ' <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER �J <br /> SETBACK AREA. , <br /> 5. GZ- l Q S� f / (rZJ/rl 03 <br /> /,, ^ �/e-- /n� C � � C)ryOQDO <br /> 6. W �M /1�K V� ( V t 94 '0 <br /> n m x e_ <br /> l MCH " o � � <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my (j p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of 0 C <br /> CL <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 'm ;a <br /> that this information 1 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 resul o t unty of Burnett relying on this information I am 'u <br /> providing in this application. I agree to permit county official =ring county ordinances or other m <br /> authorized person to have access to the above described pre r rpose of inspection. m <br /> CD :UV : <br /> SIGN HERE <br /> (signature ner or building con r n (date) <br /> ILI <br /> ZONING ADMINISTRATOR <br /> N fNl O NOO <br /> 77 UNTy <br /> TO SHIP PERMITS MAY BE} RWWD 0 0 0 0 <br />