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Burrett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator �-CD O o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> /' N <br /> fCD <br /> � L' �n .+, C <br /> OWNER / Nom, A� (/\ /�i '/!�/ -!g! TELEPHONE &9 <br /> HOME ADDRESS <br /> O <br /> EMERGENCY/FIRE NUMBER a a a 3S ROAD NAME Sp i r/7 q 11 e ,Qv <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING U GARAGE/ACCESSORY STRUCTURE ET ADDITION In PRIVY ❑ CO 0 <br /> TYPE OF PERMIT(S): c �l <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> SbX � U <br /> STRUCTURE/ADDITION USE:CJs ray r/ 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) c <br /> BUILDING CONTRACTOR: e- 6 <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR In 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p = <br /> :0 in <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m M <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C <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 o <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 /> S. 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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 'c o <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o Q <br /> CONDITIONS OF PERMIT: <br /> QJ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 <br /> ISSUANCE. p <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 1}J <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Qj <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. / [gyp�� �! /� <br /> 5. /; � 0 �tl(��t/pibT/� Q�/— ""— /I hrvv C e Q/L_ �'YjJ�� m m °r' � m <br /> 6.Qy�, 3 d, Cr4i a� � Q Q.� ' -5 'CD <br /> c o ��' 3 <br /> rn <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I 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 m 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 /> m <br /> sue a permit. I further acce t all liability which may be a result of the County of Burnett relying on this information I am <br /> providing in this applic o . 1 agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to ave ccess to the above des i pre s s at any reasonable time for the purpose of inspection. n <br /> m <br /> E <br /> // i <br /> SIGN HERE � <br /> � - 7 t<0 <br /> (sign re o owner or buildi ntractorj (date) <br /> ZONING ADMINISTRATOR N� <br /> Mrs) <br /> 0OWNSHIP PERMITS MAY BE REQUIRED 000000 <br /> 00000 <br />