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_ U� w ' ' �' <br /> m <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v0 9) Z <br /> APPLICATION FOR LAND USE PERMITS . <br /> —_ r LI) <br /> O L <br /> C <br /> 1 (D <br /> OWNER J�(..,exA 1 Me lkov% TELEPHONE 71�_ 635-- 2( I 1 a <br /> yv o <br /> 1 m <br /> HOME ADDRESS �' '71J-19 C+11 I^v` 2� O00�-CP' W l 54l�0 I v r 0 <br /> ZY EMERGENCY/FIRE NUMBER &ai cd 4y ROAD NAME Cocc_,4V L„� (ZG ( o <br /> I IF I DO <br /> W <br /> LEGAL DESCRIPTION(see tax receipt) E �d Cic..rc 5 o T S y4 S E y=1 SPci- 1 T.'49A) R.1 y I v cn `tel <br /> X' N <br /> DWELLING/BUILDING IJ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ (n <br /> TYPE OF PERMIT(S): <br /> a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION <br /> STRUCTURE/ADDITION USE: I40v-^k ❑ <br /> o_' <br /> (Home/Cabin; Commercial'Business; Bedroom; Deck;etc.) rn <br /> n m <br /> BUILDING CONTRACTOR: CD <br /> S Q ! <br /> m <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. T <br /> XI N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <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 m 30 <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. I o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO Q <br /> BUILDINGS,ROADS, LAKE, LOT LINES. qj <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 ) <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. ' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o O <br /> CONDITIONS OF PERMIT: J✓ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT { n I <br /> J <br /> ISSUANCE. U) <br /> 2. REMOVAL ORG CUTTING L TREES AND VEGETATION IS RESTRICTED ALONG UNE �� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIE ��((�l��jj-�� <br /> PERMITTED. i L1l <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN T REQUIRED WATER <br /> SETBACK AREA. <br /> 5. �7li� 7 <br /> � v � Wav v <br /> s. BURNETT COUNTY CD a ' 0 <br /> a m C N �^ o - <br /> 7. ZONING o : ,- <br /> - cn <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of rny 02 p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of �t� m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize v <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- (D <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 a m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. `D <br /> -n <br /> m <br /> CD : <br /> SIGN HERE <br /> (signature of ow er or building contractor) (date) <br /> ZONING ADMINISTRATORM / IC�1�; a <br /> L!I � 11 <br /> TOWNSHIP PERMITS MAY BE REQUIREDi <br />