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a r <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v 0 z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> y O <br /> f/1 <br /> C <br /> (D <br /> OWNER � ��� /�Li�sGti TELEPHONE 3 j� ?jjcai 0 <br /> HOME ADDRESS <br /> + r � <br /> EMERGENCY/FIRE NUMBER S � ROAD NAME ( .. <br /> X11- <br /> LEGAL DESCRIPTION (see tax receipt) l o!&M �� `f `�?� <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ ° e <br /> TYPE OF PERMIT(S): C <br /> c <br /> a <br /> FILLING/GRADING CAMPING UNIT <br /> ❑ SUBDI,pISIO�N ❑ / 5 <br /> STRUCTURE/ADDITION USE: F) 111 CEJ zkhci;db <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) C (J <br /> BUILDING CONTRACTOR: iu <br /> CDv <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 C <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m J <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y 10 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO mvj3 <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. P <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. `L <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. fV <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. (oo o <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q <br /> NEEDED. <br /> Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. r0 <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- SQUIRED WATER <br /> SETBACK AREA. / <br /> 5. / <br /> r � m = d 0r' , M <br /> 6. n xaa 10 <br /> N O <br /> 7. L� A61G m m <br /> 2 0 : :jI <br /> —_y: : i m <br /> I declare that this application (including any accompanying schedule) has b �I@ <br /> m to th est of my c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am resthe detail an¢�curacy ofall information contained in this application(including any accompanying schedu �$�a t�H�at,�Jrecognize �m m <br /> that this information I am providing will be relied upon by the County of Burnett WisconS1MYteg whether to is- o <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am w <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other to <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> CD <br /> m : <br /> SIGN HERE 440-4-07U -1Vi"9d <br /> (sign re o owner or bull n ontractor) (date) <br /> ZONING ADMINISTRATOR <br /> cn cn0 <br /> A <br /> 0 dr w <br /> N Nfn N 0 <br /> M Vt O�(n 0O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED c c c c 0o 0o <br />