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Burne t County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -CD o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> OWNER ,Tj A b- J/� go � TELEPHONE <br /> HOME ADDRESS PO 8L,x y O;Z S r- N w 7; v <br /> EMERGENCY/FIRE NUMBER 2 N T/ <br /> 7 ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) 0 Z 67r—©L�- 00 0 0 <br /> Ips (f� m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ILx PRIVY ❑ 1 C o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ �� <br /> STRUCTURE/ADDITION USE: J53AfA 5 1314620 ti-I y-o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: )/Y3 pyyo-e/ fit <br /> CDv <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/z X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 p <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p - 1jJf <br /> :0 m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n <br /> -n O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE CD <br /> C 0 <br /> NORTH 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 /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS 1 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o I <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 <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. C <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 M. WCL� m <br /> 6. <br /> R. mC o ' 3 <br /> H o n 1 <br /> Z m N <br /> 7. o <br /> lam: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Ge)-'r C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o.E <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 Burnett Wisconsin in determining whether to is- D <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other I m <br /> authorized person to h ve access to the above described premises at any reasonable time for the purpose of inspection. T T <br /> m : <br /> CD <br /> � <br /> SIGN HERE <br /> - 3-yam ; <br /> sign ture of owner b lddlnnggg contractor) (date) <br /> ZONING ADMINISTRATOR 469 40 40'A 440 <br /> VNi CNT O0N OO <br /> O 0 0 0 0 0 0 <br /> i TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />