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CVL <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872Office of Zoning AdministratorC66 o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> � y O <br /> 4J <br /> CL <br /> OWNER Ti-aA-)y TELEPHONE <br /> HOME ADDRESS L4 L( H-iq {�/= S; NE m p'j MA) 5S t_.,//, 0 <br /> EMERGENCY/FIRE NUMBER �3S(p ROAD NAME LJ eolu/UOrS �/ m <br /> �� q <br /> LEGAL DESCRIPTION(see tax receipt) Q 1 O a IU Or a �fi /• . cn <br /> n <br /> DWELLING/BUILDING 0 GARAGE/ACCESSORY STRUCTURE ❑ ADDITION X PRIVY ❑ m <br /> 0 <br /> TYPE OF PERMIT(S): c T <br /> FILLING/GRADING ❑ CAMPIN UNIT ❑ SUBDIVISION ❑ 5 <br /> STRUCTURE/ADDITION USE: cS2fr<SON U - A✓I3 t-,) 0 W C <br /> (Home/Cabin; Commercial Brn Buss; Bedroom; Dec , c.) ur (n <br /> BUILDING CONTRACTOR: ( Sa �pr� � --L- <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR C <br /> 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> � y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 V <br /> 2 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n d A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m fD <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 33 <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. 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 /> S. 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 0 V' <br /> MUST BE SIGNED AND DATED BY THE OWNER. c <br /> v 0 W <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q o, W <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z O I <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 <br /> ISSUANCE. )I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. o <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. tido C7►ucµtifi Or l l c,, ,n S O�} - v ^!�'1 <br /> VV U .XM0 3r- � 0ka -0 <br /> m m m <br /> 6. 3 am XQ 70 <br /> 9 m c N N o 3 3 <br /> 7. z !� � ' ' ° =1 <br /> O 70 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ` c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of C <br /> CL <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognizem M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- p <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> to <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> m : <br /> a m : <br /> SIGN HERE 0e6&yL0kZ If <br /> ( <br /> (signature of owner or ilding contractor) (date) <br /> ' <br /> ZONING ADMINISTRATOR v/m . • . <br /> to cn cn w <br /> N N f7 N O <br /> VI N O VI O <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 0 <br />