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&np <br /> Bur-tett.`aunty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> 1— <br /> rn o <br /> 111C�`Gf4 � C,I <br /> OWNER TELEPHONE <br /> m <br /> HOME ADDRESS <br /> 3l D 6y S7. L I'1'J,v• ��S/cam v <br /> EMERGENCY/FIRE NUMBER O�O LD ` LI ROAD NAME cSCtNrLSe Ot ti <br /> —{— P <br /> LEGAL DESCRIPTION (see tax receipt) v t l� UwPtSe- CD <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE USI ADDITION ❑ PRIW ❑ lcn 0 <br /> I <br /> TYPE OF PERMIT(S): ccr <br /> FILLING/GRADING ❑ CAMPING UNIT,p SUB IVISION ❑ <br /> STRUCTURE/ADDITION USE: <br /> Home/Cabin; Commercial Business; Bedroom; Deck; etc.) co <br /> BUILDING CONTRACTOR: <br /> m _ <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 x <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. See f '�rtaj"Lc � — 1� <br /> V 0 c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) Ll O a O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). a <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. `Z Q <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. f I <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED. Q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o C <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. O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY G <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHINi ER <br /> SETBACK AREA. <br /> 5. -9 <br /> 6. 0 < 3 o 0 s P CD M <br /> _ SEP 1 2001 -2 . MC00 -59 <br /> VN O <br /> 7. e U o O <br /> ;, 1 m <br /> I declare that this application (including any accompanying schedule) has been examin ® e t of my A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsi a accuracy of $' <br /> all information contained in this application(including any accompanying schedule)and I furtheV Iare that I recognize m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 <br /> authorize pe on to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> T <br /> (D <br /> SIGN H RE <br /> (sign re of o building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> e <br /> c <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />