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Burnett^ounty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Admin strator 0 0 <br /> CD APPLICATION FOR LAND USE PERMITS 3. <br /> r Q \ <br /> // C <br /> OWNER �T�Vy spQ � TELEPHONE T&9— p?q o�C;�' <br /> HOME ADDRESS <br /> Gly 7 0 (/1 <br /> EMERGENCY/FIRE NUMBER �O ROAD NAME Lal <br /> LEGAL DESCRIPTION(see tax receipt) <br /> ��f pppWm <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION PRIVY ❑ ` Co o C_ <br /> TYPE OF PERMIT(S): C <br /> Cr <br /> FILLING/GRADING ❑J CAMPING UNIT ❑ SUBDIVISION r❑ • 5 <br /> STRUCTURE/ADDITION USE: r /� c� /T`1(�{��I�YI r � 0 <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) m <br /> ' "'/p <br /> BUILDING CONTRACTOR: — r -, -Sh PII <br /> ,0� s <br /> v � <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8Ya X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. (� <br /> M N \ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> m °- <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 'I <br /> NORTH(N). N o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m _ <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 /> 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 OG <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHENq 0 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: <br /> n <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. AllI <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. fw- <br /> 3 NOGRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> zv0r�a 0 -V <br /> 7. Z : a <br /> o <br /> eco. 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 m <br /> CL : a7 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 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 tel: d <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. n <br /> M :el : <br /> SIGN HERE ' a - lq <br /> (si a ure of ner or building!jr r) (date) <br /> ZONING ADMINISTRATOR • . • . . <br /> fn fn fn fn fn to- <br /> N W N "0 (II <br /> Vt (TO(T(TOO <br /> NSHIP PERMITS MAY B REQUIRED 0000000 <br />