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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator z <br /> APPLICATION FOR LAND USE PERMITS 3 ° <br /> o y`) <br /> OWNER 4'11 US TELEPHONE <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER ROAD NAME�J ' IIS K� <br /> LcIA 2.-- cS m Sp - NwC —SLV 4 <br /> QC- <br /> LEGAL DESCRIPTION(see tax receipt) 4/h Jl —Q v J� �� 1 N <br /> lJ 0 <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ o <br /> TYPE OF PERMIT(S): , J <br /> FILLING/GRADING CAMPIN UNIT ❑ SUBDIVySION ❑ a <br /> (/— b or <br /> 5. <br /> STRUCTURE/ADDITION USE: ✓�^ V.e_c. ��• too. <br /> (HoCabin; Go m ercial Busine s; Bedroom;Deck;etc.) y <br /> BUILDING CONTRACTOR: I Itf, Vt_V� > <br /> (D <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> x m <br /> DIRECTIONS FOR PLOT PLAN DRAWIN • (AERIAL OR TOP VIEW) O CD <br /> m a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Tcy <br /> z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m d � <br /> NORTH(N). C _ 1 <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 1 <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 C <br /> MUST BE SIGNED AND DATED BY THE OWNER. c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN0 <br /> NEEDED. -r ° { <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> CONDITIONS OF PERMIT: P <br /> I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT G <br /> ISSUANCE. 1 h <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 1 �t <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 Q <br /> SETBACK AREA5. <br /> .r� <br /> 6. A -U0r 0� 0 � <br /> B m <br /> m � onm �� _ ,;U <br /> (D C N y J <br /> 7. Z R N O : Co i <br /> O � �: <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Vi�cXI <br /> pm <br /> knowledge and belief it is true,correct and complete. I acknowledge that I 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 C m : m <br /> CD <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is 0 <br /> sue a permit. I further accept all liability which may be a result o th �l urnett relying on this information I am <br /> providing pp P ty <br /> p gin this a lication. I ree o ermit coun officials a t t ordinances or other �` ` <br /> authorized pens to have acces to th above described premis t r e of inspection. <br /> m : <br /> SIGN HERE f <br /> (D b> <br /> (sign ure er or building contrac 2 1 ate) ; a <br /> i E i <br /> ZONING ADMINIST T R ^ <br /> to cn fA to fA <br /> Nn P 0 <br /> N C"Nut (TO <br /> TOW SHI PERMITS MAY BE REQ EDG 0 0 0 0 0 <br /> 00000 <br />