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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v ° Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> �.� 0 (I 1 <br /> CD <br /> OWNER �LeGCblN O� (� TELEPHONE �iO w <br /> 6001 <br /> HOME ADDRESSd� 4Q h u 0 <br /> 0 m <br /> EMERGENCY/FIRE NUMBER SAY»� ROAD NAME I c <br /> GL _t�U_�l� I <br /> LEGAL DESCRIPTION(see tax receipt) rn <br /> CD <br /> a <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION PRIVY ❑ o) 0 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ //C��A__MPING UNIT ❑ SUBDIVI a <br /> STRUCTURE/ADDITION USE( >rl('i G� O N� f � /(f® 0' <br /> (Home Cabin ommercial ness; Bedro�o /uqV;etc.) co �^ <br /> BUILDING CONTRACTOR: _'3`E' '1^ . X l"•"-'-• <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 77 SHEET OF PAPER. ANY INCOMPLETE OR 3 ^ , <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T 3. <br /> O — <br /> � y c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p � <br /> T a <br /> TI Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m d A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO IM �3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 10Z <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. <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 ) o <br /> MUST BE SIGNED AND DATED BY THE OWNER. c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN a ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z ` <br /> CONDITIONS OF PERMIT: <br /> o (�' <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. SO <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 (� <br /> SETBACK AREA. <br /> 5. 9 , Q <br /> 6. h � � � v 9 C CD ;d <br /> CDZ CODO <br /> =N7. (f C'� 09 <br /> Em <br /> I declare that this application (inc d g any accompanying schedule) has been examined by me and to the best of my 3.r : <br /> 7 c C <br /> knowledge and belief it is true,coirredt and complete. I acknowledge that I am responsible for the detail and accuracy of m _ <br /> all information contained in this application(including an accompanyingschedule and I further declare that 1 recognize m m im <br /> pP ( 9 Y ) 9 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- �d 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 Q ? m <br /> authorized person to have access t9 the above described premises at any reasonable time for the purpose of inspection. m <br /> m : <br /> CD-749 : <br /> SIGN HERE <br /> gnatur f owner or b Id' g c cto (date) i <br /> ZONING ADMINISTRATOR 0164 fA <br /> cn cn <br /> N N (TNN010 <br /> IT (TO [T [TOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED ( 0 0 0 0 0 0 0 <br /> 0000000 <br />