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Burnett C;Unty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 O z <br /> APPLICATION FOR LAND USE PERMITS 3 ` <br /> ✓ ` N O <br /> ,✓ C <br /> OWNER n <br /> TELEPHONE <br /> O <br /> io <br /> d_ <br /> HOME ADDRESS/ / aoy1 Az 3 0 <br /> EMERGENCY/FIRE NUMBER �2� ROAD NAME <br /> 0 <br /> LEGAL DESCRIPTION(see tax receipt) 6, m <br /> DWELLING/BUILDING Kle GARAGE/ACCESSORY STRUCTUREIT4DITION 1:1 PRIVY, m 0 <br /> A <br /> TYPE OF PERMIT(S): ❑ �q D e ( /a Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBD VISION rltrl °` a <br /> STRUCTURE/ADDITION USE: �D �LlrC 0 <br /> Home/Cabin; om rcial usiness; Bedro Deck;etc.) <br /> BUILDING CONTRACTOR:,, <br /> y <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> N , <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) Om <br /> n G. <br /> ?� z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m :° <br /> NORTH(N). C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO M3 <br /> CENTERLINE <br /> 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF v 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 Q <br /> BUILDINGS,ROADS,LAKE, LOT LINES. (� <br /> 5. 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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. ,o c <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q o <br /> NEEDED. �� ) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> CONDITIONS OF PERMIT: P Jv <br /> I <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 RETAIIN,IINGGpWALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA.5. <br /> ✓� '���v — n <br /> U . d m i two L m <br /> (j_� / Q m <br /> 6. �1 / g � a no e � <br /> �, � ? (P m o E 65, rb <br /> 7. AUG 1 0 1 z : i � <br /> P : <br /> _ n: '. m <br /> I declare that this application (including any accompanying schedule) has been a yy by me and to the b f my c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am resA 1r7Wfiling <br /> )I�q y cy of d C <br /> all information contained in this application(including any accompanying schedule)and I fg�f��(r' 4�thitlt recognize � m A <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin-I 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 d <br /> providing in this application. I agree to permit county officials charged with administering coLInty ordinances or other m <br /> authorized persop4p havq acce s to the above described premises at any reasonable time for the purpose of inspection. m <br /> m : <br /> SIGN HERE t jJ'per 9� <br /> (signature n orb kyn9 or) (date) <br /> ZONING ADMINISTRATOR <br /> N N N N ut <br /> U1 V• V1 V1 O <br /> T04SHIP PERMITS MAY BE REQUIRED <br />