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Burnett County 7410 Co.'Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator V c� T Z <br /> APPLICATION FOR LAND USE PERMITS a o <br /> r <br /> N ,0� <br /> I H <br /> OWNER loUCe � m� / / TELEPHONE <br /> HOME ADDRESS 33a� CG(mMtn � suoeri4r Qq sy�J <br /> EMERGENCY/FIRE NUMBER (�3 r5 ROAD NAME 0���`S Lt~ 1 W <br /> ? 4 <br /> LEGAL DESCRIPTION (see tax receipt) L cr/ 3-t q Vol <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTUW M ADDITIONL�J" PRIVY ❑ 1 � <br /> Cn <br /> 0 <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING 1:1CAMPING UNIT ❑ SUBDIVISION El CL <br /> H <br /> STRUCTURE/ADDITION USE: t '4&A 4— <br /> I (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) cn W <br /> BUILDING CONTRACTOR: <br /> 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m � o <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a W d <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n obi <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). CO) 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO MW 3 <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. P <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. I <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. IN <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. to o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN Cr 0 W <br /> NEEDED. N <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o Q <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. (n _I Q. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY `�',► /U"� <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. o y� <br /> /W u� ry <br /> co 0 <br /> Z m N !R 7,9 =j <br /> 7. o <br /> ern :Ct m <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of Q ii <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m ("D m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ': v <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other CD <br /> to <br /> authorized person to have access to the above descri r at any reasonable time for the purpose of inspection. <br /> m <br /> J i m <br /> SIGN HERE <br /> P 840 <br /> (signature of w er Iding co ctor l I (date) <br /> ZONING ADMINISTRATOR <br /> l ri w 01 to Fn <br /> N N 01 N N N <br /> Ot 01 O V1 VI O <br /> TOWNSHIP PERMNY 1f MED 0 0 0 0 0 <br /> ZONING <br />