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On C'e� <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v c) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N 0 <br /> CyC <br /> OWNER ���p�+"1 TELEPHONEft <br /> o (j n <br /> HOME ADDRESS '30QO C:O OAIGeJOpQ O <br /> EMERGENCY/FIRE NUMBER a / qlq ROAD NAME w <br /> i ^ <br /> LEGAL DESCRIPTION(see tax receipt) �— See <br /> ® m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE i ADDITION PRIVY ❑ Co <br /> TYPE OF PERMIT(S): C <br /> FILLING/GRADING 0 CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: Cc.j POP-00,c <br /> nh /a X 'L/ c <br /> SC <br /> (Home/Cabin; Commercial Business; Bedroom Deck;etc.) co <br /> BUILDING CONTRACTOR: /VOILTIi�p r✓p /�L W v l <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. �f <br /> DIRECTIONS FOR PLOT PLAN DRAWIN • (AERIAL OR TOP VIEW) <br /> c <br /> n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. In Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). a 0 <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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. c <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 � w <br /> MUST BE SIGNED AND DATED BY THE OWNER. f� g o k <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. 0-- <br /> THIS <br /> `THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z n. <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. Q <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. f <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED ATER ,\N <br /> SETBACK AREA, <br /> 5. ooew6. W <br /> 7. 1 : ,00 <br /> ZyMQi 1 <br /> o . <br /> I declare that this application (including an accompanyingschedule has been examined by me and to the best of my � 3 c p <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 ofm it : : C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize C�Nm m m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- E 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 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> m <br /> CD : <br /> SIGN HERE 9 �S 5 �+ <br /> (s nature f owner orb ntractor) (date) <br /> ZONING ADMINISTRATOR <br /> rntnfnfnfnrn� <br /> N NCn NNG1 (T <br /> (T NO (11N00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 or o <br />