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Wvyq <br /> Burnett Count-, 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS I <br /> H <br /> C <br /> OWNER J E6 Cf' TELEPHO._7/1� ;1 G 4 •. 71 t/ p <br /> i✓L u' C,q <br /> HOME ADDRESS / /V. / l;i �• �� ,�I�1N., �nJ S ��j� �j <br /> I ) 0 <br /> EMERGENCY/FIRE NUMBER G ROAD NAME <br /> 2 6 r <br /> y"y� <br /> LEGAL DESCRIPTION(see tax receipt)10 Lt�rCc <; /7j Cn <br /> m <br /> n <br /> v <br /> DWELLING/BUILDING ElGE/ACCESSORY GARASTRUCTURE ❑ ADDITION PRIVY ❑ C <br /> TYPE OF PERMIT(S): ., <br /> ❑ �c.G3 s/B�.^/ � o; <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ✓ S. <br /> STRUCTURE/ADDITION USE: �' �G''� �f':Z1t6.� DY Lt-�f E"t C"^1 UP: /'✓/G <br /> 1k (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) U " <br /> BUILDING ONTRA�TCQY-1 ML, <br /> a <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCeUPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) c <br /> In C) <br /> CD <br /> 'il <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. v <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). o <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 O� <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <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 /> 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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o 0 <br /> I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q <br /> NEEDED. <br /> r ���v fffl <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. <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 /> 5. <br /> SETBACK 2 REA-i�� / u, /^n b51— 7' & A U- A/U <br /> 6. 2. mcu 003_ <br /> pl O 0 <br /> 7. <br /> o rn m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c ID <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of n E <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- t7 <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other i m <br /> authorized person to naNfe access to the,4bove described premises at any reasonable time for the purpose of inspection. T <br /> ro <br /> CD : <br /> SIGN HERE <br /> sig ture of ownerW building contractor) (date) <br /> ZONING ADMINISTRATOR <n t»to fn w w�' <br /> N NNNN VIN <br /> Vt 0O ON OO <br /> O 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />