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Burr*W:;"unty 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 /> N o <br /> C <br /> TELEPHONE-P 5 3 S -7 S <br /> 72 <br /> O <br /> HOME ADDRESS aG �UCr �� �I �E �� �� � o'I ty✓� \ <br /> EMERGENCY/FIRE NUMBER r ROAD NAME <br /> 60v, <br /> � <br /> LEGAL DESCRIPTION(see tax receipt) Pei, Wy`t, (i�-, <br /> W 0 ((R <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION WPRIVY ❑ N oma' V' <br /> TYPE OF PERMIT(S): a3 <br /> Cr <br /> FILLING/GRADING ❑ CAMPI UNIT ❑ SUBDIVISIO ❑ L1 <br /> n '/ 5. <br /> STRUCTURE/ADDITION S p O a C FIC D of K�a <br /> ( me/Cabin; Commercial Busi ess; Bedroom; Deck;etc.) y <br /> m <br /> BUILDING CONTRACTOR: EL F <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> 0 H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 c <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m I <br /> NORTH(N). <br /> 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDINGS)TO ALL LOT LINES,(B)BUILDING(S)TO m <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. o <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 t,1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. to o Y <br /> o 0 Q <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Cr <br /> NEEDED. n 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: <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. <br /> CD 0 m <br /> 6. Ips 3 n Ow <br /> ICD C N N 0 <br /> 7. O . <br /> =y: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofC <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of yr Ing whether to is- p <br /> sue a permit. I further accept all liability which may be a result of the� mcn; <br /> �this information I am m <br /> providing in this application. I agree to permit county officials char antes or other m E E <br /> authorized person have access to the above described premises at reasonable time for the purpo44 of inspection. -n <br /> OCT i <br /> two 3 <br /> SIGN7GADMINISTRATOR <br /> (sig tur of owner orb Ild contractor) BURNETT COUNTY <br /> ZO NG <br /> CSN NNN0, <br /> V1 Ill pO V1 V1 Oo O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br /> 0000000 <br />