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Cbz <br /> Burnett Co}fnty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> ACL <br /> PPLICATION FOR LAND USE PERMITS 3 <br /> ; O <br /> N _ <br /> OWNER `// ,7 / TELEPHONE n <br /> HOME ADDRESS y v <br /> m <br /> EMERGENCY/FIRE NUMBER `77b 7 '7 j d. ROAD NAME <br /> 4 cZ <br /> LEGAL DESCRIPTION (see tax receipt) �S"/ # J�20lo (/d`v.nQ /j� #6C1 9/� <br /> � <br /> , <br /> DWELLING/BUILDING .Idyly GARAGE/ACCESSORY STRUCTURE ElADDITION ElPRIVY El ( � <br /> TYPE OF PERMIT(S): a ' <br /> or <br /> FILLING/GRADING ❑ CAMPI G UNIT ❑ SUBDIVISION ❑ a <br /> N <br /> STRUCTURE/ADDITION USE: P G/f 6i Z <br /> ( ome/Cabin; Commercial Business; Bedroom; Deck;etc.) Cn <br /> BUILDING CONTRACTOR: SELF s, O <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T C3. <br /> D � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> XL <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) Oo v 1 <br /> TZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C7 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m :° <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO rn 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 <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 <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z d <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT tl 1 <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 /> SETBACK AREA. <br /> 5. <br /> ;a -oC)r OkO -o <br /> m <br /> 6. t�.� 3nNX�- � <br /> m CUS 0 �7 M <br /> 7. o i <br /> =0) : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my r Cr : : C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of 3 n IF <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m E ': 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 m <br /> authorized person to Infige access to the ascribed premises at any reasonable time for the purpose o nspection. n <br /> Z j <br /> SIGN HERE � • <br /> (signmoe ofow er or building ntractor) ate) <br /> ZONING ADMINISTRATOR f v+ <br /> N <br /> PO NM( P <br /> PV1 f71 N <br /> (rO O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />