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1 /�'7 <br /> Burnett county 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v 075plz <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> Q <br /> &J <br /> OWNER TELEPHONE CD 471G/ ��6 _ ���/ <br /> HOME ADDRESS 3 e- 7 / �,_._ �S� �� CDS <br /> EMERGENCY/FIRE NUMBER S p a ROAD NAME3 4 7 <br /> C�l <br /> LEGAL DESCRIPTION (see tax receipt) ih ' ! / c/,� P r <br /> CD <br /> DWELLING/BUILDING Lam} GARAGE/ACCESSORY STRUCTURE ❑ ADDITION Ll PRIVY ❑ rn <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> < <br /> in <br /> STRUCTURE/ADDITION USE: / ell k( i" ( moo <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) y <br /> m� <br /> BUILDING CONTRACTOR:_ <br /> G <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> DIRECTIONS FOR PLOT PLAN DRAWING, 0 ="r <br /> (AERIAL OR TOP VIEW) 0 <br /> m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. In I P Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE n <br /> M <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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. � Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO 0 <br /> BUILDINGS,ROADS, LAKE, LOT LINES. 1 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. oa N Q <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. 0,0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONEWHEN q 2%,) <br /> NEEDED. a 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z �U <br /> CONDITIONS OF PERMIT: P o0 <br /> 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMITC> <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. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER VJ <br /> SETBACK AREA. <br /> 5. <br /> 6. .7�fJ+-i—t"T 1.��/ CD � W O nD t7 <br /> _ // m '`c (D CL M <br /> ( ` /� <br /> CD C N y 0 3_ <br /> 7. /Vl Z�CJ Z Vl 'C40 <br /> 0 r� <br /> I declare that this application (including an accompanyingschedule has been examined by me and to the best of my cj r i i m <br /> PP C 9 Y ) —a : : A <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of �+ m C <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,t ounty of Burnett Wisconsin in determining whether to is- O <br /> sue a permit. I further accept all liability which may be 4 ounty of Burnett relying on this information I am <br /> providing m <br /> p gin this application. I agree to permit county car dministering county ordinances or other � <br /> authorized person to have cess to the above de cd prem ime for the purpose of inspection. <br /> /� p CD <br /> SIGN HERE Yr VEp r i/ S-- con • <br /> (si owner r bull iPy co ract r) 1 /� (date) <br /> ZONING ADMINISTRATOR 17 i <br /> NDINN (TN <br /> Vt 00 (70100 <br /> OWNSHIP PERMITS MAY REQU RED B o 0 o g o g <br />