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Burneft County 7410 Co. Rd. K, No. 102,Siren, WI 64872 Office of Zoning Administrator -o G) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> 0 <br /> rn o <br /> N <br /> C ' " <br /> � Int s�� �5 n � <br /> OWNER TELEPHONE <br /> 2S- 6 97 - ,23 <br /> CQ� ] Op ICD <br /> HOME ADDRESS a3�M F ` j) � �Clt ��f� Or st'r Il/ I^ v <br /> r- m <br /> EMERGENCY/FIRE NUMBER ROAD NAME F10�/C� I Gh K,e r <br /> I <br /> LEGAL DESCRIPTION (see tax receipt) rn <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION PRIVY ❑ N0 <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING ❑I CAMPING UNIT ❑ SUBDIVISION ❑ <br /> Ln <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) rn <br /> 2. <br /> BUILDING CONTRACTOR: CD <br /> 5e ' <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O �J <br /> �1 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <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 <br /> NORTH(N). CO) o <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 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 0 t <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN Cr <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: c <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT v <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. R <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER �7 <br /> SETBACKo'A�R(JE.�q L (,T�/y /�(/ <br /> 5 SLI 1410 . <br /> 6. C'DD CLac y N o = 3 <br /> 7. Z : w CDS 'CP =j <br /> o : <br /> o,: [ 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 IF <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize m (D 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 /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am I m E <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. T <br /> m : <br /> CD <br /> SIGN HERE l <br /> (signatu 9of o er, i ding contractor _ da ) <br /> ZONING ADMINISTRATOR <br /> to Fn to fn N w <br /> N N N N N P CA <br /> 0 <br /> (T C71 O N f71 O O <br /> `TOWNSHIP PERMITS AY BE REQUIRED 0 0 0 0 0 0 0 <br />