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sllwoy� <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ' 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> UT o <br /> m <br /> CD <br /> OWNER �d 4 TELEPHONE i o <br /> HOME ADDRESS v C( <br /> cj .fA.v�' 1yJ f v I <br /> 0 <br /> EMERGENCY/FIRE NUMBER 3 ROAD NAME e `Ss <br /> LEGAL DESCRIPTION(see tax receipt)' �� G� A t c5g�" <br /> CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITIO 1� PRIVY ❑ m o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING <br /> �❑y CAMPING UNIT ❑ SUBDIVISION ❑l O 5 <br /> STRUCTURE/ADDITION USE: -;�h'eLcl- '/L , <br /> (Home/Cabin; Commercial Business; B room; Deck; <br /> etc.) / m <br /> BUILDING CONTRACTOR: /V(JZ�/J� hJ� .�jd• <br /> 1 <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR T '3_ <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> 0 � d <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n a <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 1 9 <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. c <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO ll <br /> BUILDINGS,ROADS, LAKE, LOT LINES. �Vp <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <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. o <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a 0, <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: Q <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 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> Xv0r- > 0>> 0 -0 <br /> CD M. m Cm m <br /> s. <br /> COD CL .;D <br /> CD C 'W <br /> 7. <br /> o <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my cj c p <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 /> CL <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- O <br /> sue a permit. I further accept all liability which may be a resul .the County of Burnett relying on this information I am m <br /> providing in this application. I agree to permit county official a ministering county ordinances or other m <br /> authorized person to have access to the above described prem 'e the purpose of inspection. T <br /> CD : <br /> / I m : <br /> SIGN HERE ' D <br /> (si a re of o n or building cont ) Ap �t �Q (date) <br /> 01 <br /> ZONING ADMINISTRATORAj NrT <br /> wFn4A 40 40 P01P <br /> N [nNNN <br /> Ut O f11 N O <br /> TOWNSHIP PERMITS MAY BE t130, <br /> VnNE�NTY I 0 0 0 0 0 <br /> 0o0o0 <br />