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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ,V -0 <br /> O <br /> APPLICATION FOR LAND USE PERMITS CD <br /> 3 <br /> r <br /> /� /� / -7 <br /> 41 <br /> OWNER �1����� �T-}{l J/ /� TELEPHONE2/- (j�tv "�� Q CL <br /> HOME ADDRESS ?6 r <br /> EMERGENCY/FIRE NUMBER Cj d 2 6 7 ROAD NAWCIOT �Ijl,)Ed _ <br /> I <br /> LEGAL DESCRIPTION(see tax receipt) R T _ _�� m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ ) y <br /> TYPE OF PERMIT(S): Q c <br /> v"I c <br /> FILLING/GRADING CAMPING UNIT El SUBDIVISION ❑ CL: <br /> / � I <br /> STRUCTURE/ADDITION USE:_ PrRPfol Coe YOR o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: tv <br /> CDv <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR VN <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n 3 <br /> O ir <br /> DIRECTIONS FOR PLOT PLAN DRAWING' (AERIAL OR TOP VIEW) 0 m <br /> n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> m 9 z <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 IM <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. o <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 0 I <br /> MUST BE SIGNED AND DATED BY THE OWNER. S c <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHENq o <br /> NEEDED. o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: ° <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 RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER I <br /> SETBACK AREA. <br /> 5. <br /> 6. 0J <br /> a c <br /> N C N N O S _K <br /> 7. Z ; y N <br /> O MI declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> =y :f� i7 Cr m <br /> m <br /> JD <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of Q m' <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ��(�' mm ;a <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized VF?"n to have access to the above described premises at any reasonable tiffte for the purpose of inspection. T <br /> m <br /> (D <br /> SIGN HERE — 00 <br /> re of owner r,b ilding contractor) "(date) <br /> ZONING ADMINISTRATOR1007 <br /> • ' <br /> wFn fnw� <br /> N N N C n <br /> (P (n fly O P o <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 <br />