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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v 0 Z <br /> APPLICATION FOR LAND USE PERMITS _ 3. <br /> ir <br /> �pc o <br /> OWNER 8 1\7 L + j-1 1 TELEPHONE 63� o W <br /> HOME ADDRESS / S F� �D 'V �. w'�' � v W <br /> 5t <br /> ('" <br /> EMERGENCY/FIRE NUMBER t� J ROAD NAME 00 (f I <br /> pvT LOT 10 3q -I <br /> LEGAL DESCRIPTION (see tax receipt) / C S m v 9 .. , 1 Q J✓ <br /> C <br /> DWELLING/BUILDING ❑ ARAGE/ CESSORY STRUCTURE ADDITION ❑ PRIVY ❑ O <br /> TYPE OF PERMIT(S): ( w ' <br /> Cr <br /> FILLING/GRADING 1:1 <br /> CAMPING1 UNIT ❑ SU13DIVISSIION ❑ y� / (� 'v� 5 <br /> STRUCTURE/ADDITION USE: 1�E 1 � �rl �� �T R 7Y V- ` 0 O <br /> I (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) or <br /> BUILDING CONTRACTOR: CCD <br /> v <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. m <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m • <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 m v <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. 0 <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. So <br /> O 9 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q S <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z (( <br /> CONDITIONS OF PERMIT: � QI <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT lam, <br /> ISSUANCE. V <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 -00 � �D0 0 .0 <br /> 6. <br /> CD �. d j O 0, O.9 m <br /> CD C N y 0 3 <br /> 7. O N ' <br /> Cl) m <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my Lj c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize (� (Dm m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- d: �, O <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 \J <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other m <br /> authorized person ve access to th bo describ d premises at any reasonable time for the purpose of inspection. T <br /> m <br /> m : <br /> SIGN HERE <br /> r[Aignature <br /> 'offoo ger or uilding contractor) (date) <br /> ZONING ADMINISTRATOR U1(1� IllaVyti <br /> n fA 49to 69 <br /> N N N Ot N <br /> fT fT V1 O O <br /> O O O O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED ,b o 0 : 00 <br /> fR <br />