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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v G) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> or <br /> y O <br /> OWNER Qj <br /> l� o�n fGti TELEPHONE <br /> HOME ADDRESS �� �� � <br /> r m <br /> EMERGENCY/FIRE NUMBER ��� ( ROAD NAME A �IC <br /> LEGAL DESCRIPTION(see tax receipt) 110PL L a itil �7 W <br /> v� n 1 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE L�(J ADDITION ❑ PRIVY ❑ <br /> TYPE OF PERMIT(S): C v, <br /> FILLING/GRADING ❑ CAMPING UNIT F-1SUBDIVISION ❑ a <br /> 5. <br /> STRUCTURE/ADDITION USE: N. <br /> 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> �/ y ' <br /> BUILDING CONTRACTOR:�// {cr/ -2V 2 /j�U Il �O1(1Q 4 <br /> T <br /> at <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. //� G rX] .n 3. <br /> DIRECTIONS FOR PLOT PLAN DRAWING• (AERIAL OR TOP VIEW) see ('grm✓- � I 1 V 0 <br /> yO m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Zr J r n <br /> v <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 (� 3 <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. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO o <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o JCJ <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a <br /> NEEDED. ;i <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z C G <br /> CONDITIONS OF PERMIT: o kA <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. 1 <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. 61 <br /> 5. <br /> 6. m � 3� Qk m <br /> toy C=L SL: <br /> 7. Z N N O 'o <br /> P <br /> I declare that this application (including an accompanyingschedule has been examined by me and to the best of my `J i of Cr <br /> m <br /> PP ( 9 Y ) _ <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d 0 C <br /> Er <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m mi i 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. 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 W: <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m ' <br /> mE <br /> SIGN HEREC� <br /> (si TOWNSHIP <br /> owner or building con ctor) (date) / <br /> ZONING ADMINISTRATOR <br /> cn to cn cn ww En <br /> f11 N N 01 fT <br /> /V/tl b Vt N O N fn O O <br /> PERMITS MAY BE REQUIRED 1 0 0 0 o o 0 o <br />