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Burnett CEunty 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 /> / <br /> OWNER hQ(�r�i9eePL�cXerso� TELEPHONE 1�? 1,7— 69',j <br /> HOME ADDRESS l / 6 3 dVtiC) To�1 �i t^�°�eINLSU• Il" 11r l� X533`7 v <br /> r � <br /> EMERGENCY/FIRE NUMBER ROAD NAME ( / <br /> d <br /> LEGAL DESCRIPTION(see tax receipt) Ll ( � <br /> n <br /> c <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ rn <br /> TYPE OF PERMIT(S): v ' <br /> FILLING/ DING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> N <br /> STRUCTURE/ADDITION USE: Wlfi ° <br /> � a <br /> �� H me/Cabin; Commercial Business; Bedroom; Deck; etc.) ur <br /> BUILDING CONTRACTOR: S <br /> 1 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> 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 d <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). 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 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. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <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. 0c0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Cr <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z V <br /> CONDITIONS OF PERMIT: P G <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. W <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. q,4 <br /> a � <br /> 'CD Cy . o � � <br /> 7. c m <br /> ly: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my L7 c ID <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail andaccuracy of o <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize j 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 /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am m <br /> providing in this appli ation. I agree to permit county officials charged with administering county ordinances or other d m <br /> authorized person to yove access ove described premises at any reasonable time for the pu pose of inspection. m <br /> : <br /> SIGN HERE � <br /> (signatu f owner or buil contractor) (date) <br /> ZONING ADMINISTRATOR ' to <br /> Vt O Cn VI 0 0 <br /> OWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 <br />