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Burliett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Adistrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS �- <br /> p r/ � _ I <br /> OWNER G. N/�!z b TELEPHONE .3�I!"a.�' / !� o p <br /> HOME ADDRESS 2I2AlV9 �2y yfieSN /eG m O <br /> r m <br /> EMERGENCY/FIRE NUMBER j ROAD NAME e/Z/SAIgAW2y DO 0 <br /> /I I <br /> LEGAL DESCRIPTION (see tax receipt) — 3�_ / C <br /> CD <br /> DWELLING/BUILDING 11GARAGE/ACCESSORY STRUCTURE ® ADDITION El PRIVY ❑ <br /> O c o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: 4;�-Ax/;;L� o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) Cn O , <br /> BUILDING CONTRACTOR: /3/I?Uk'c <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n 3 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p <br /> CL <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. -n o <br /> Z <br /> n z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 1 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF L/� o� <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. I <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. oN <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. 2 C <br /> 0 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN o <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 O <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 SPECIFICA Y <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING')WALLS, ETC ,AsLLOWED QT�HIN TH/ <br /> A. <br /> 5. SETBACK "I O 6� " " VC i ( <br /> 6. This structure to be used as private residential ,4010 2 \��1JJ a ; E g C <br /> 7. garage/storage only. Not to be used for human U Q Ji]n� c N " o M 3 <br /> y <br /> habitation. !T . p <br /> I declare that this application tmcivaing any accompanying schedule) has been examine e e b t L my e <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible f a�'t'/��'�'t1I� curacy of �' m <br /> all information contained in this application(including any accompanying schedule)and I further de are threcognize ; <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 /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> CD <br /> CD <br /> u� <br /> SIGN HERE <br /> (signature of owner or building c ctor) (dat ) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PE MITS MAY BE REQUIRED ? r�� <br />