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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v C) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> y <br /> ✓/ / /1� m w <br /> OWNER . m / Cv� TELEPHONE <br /> G J �'/ L /r/ m_ � <br /> HOME ADDRESS 5,t ( /`J/ p //�r <br /> EMERGENCY/FIRE NUMBERNAME <br /> OAD 00.44-/-��_J7d �T <br /> ROAD <br /> 11 L <br /> LEGAL DESCRIPTION(see tax receipt) y �m Ss ( rgp woe <br /> / T�AP/1� 0) <br /> 1 N CD <br /> 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ c <br /> FILLING/GRADING El CAMPING UNIT ❑ SUBDIVISION ❑ ? , <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) y <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 6'/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T - <br /> O " 1i' <br /> .0 W <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) W <br /> O W <br /> W <br /> In cL <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T0 Z <br /> Ri 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m T A <br /> NORTH(N). C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO CO) <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 O <br /> BUILDINGS, ROADS,LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N O <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. c <br /> g <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHENq o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> CONDITIONS OF PERMIT: P <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. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 1 i <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> � a)iu a 0 'a <br /> 6. CD L rn <br /> COD CL OX x <br /> 'O N C H N O <br /> 7. Z N N O <br /> _Cn : <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my m <br /> Lj c p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o, 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 the County of Burnett Wisconsin in determining whether to is- p <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 abovdescribed premises at any reasonable time for the purpose of inspection. <br /> m <br /> m : <br /> SIGN HERE �!/�`-00 <br /> (signa of owner or bullding n ractor) (date) <br /> ZONING ADMINISTRATOR <br /> 169 49 V ot»cn� <br /> N N VIN N Vt N <br /> VI N O ut [T O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />