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(7-;�6c-� <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 0 o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N <br /> C <br /> TELEPHON <br /> OWNER .K V L�jCS ���jr, &5 <br /> qQ2 $j <br /> HOME ADDRESS !D J �(,{ V 30 <br /> r <br /> EMERGENCY/FIRE NUMBER �J� ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) L� C Sh i 1 <br /> a <br /> m o <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION U PRIVY U C 0 <br /> Cr <br /> TYPE OF PERMIT(S): q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ S. <br /> elno <br /> STRUCTURE/ADDITION USE: rl1G WI"` <br /> Home/Cabin; Commercial Business; Bedroom; Deck;etc.) y <br /> i-� <br /> BUILDING CONTRACTOR: � <br /> m (^ <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -M 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. c <br /> CL <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR CD <br /> TOP VIEW) O v Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m I <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C c <br /> NORTH(N). to <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 \ c <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <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. N <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 7 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS o \ <br /> MUST BE SIGNED AND DATED BY THE OWNER. p <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN g <br /> NEEDED. <br /> Z 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITlnNs OF PERMIT: W <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 <br /> SETBACK AREA. /.� �_,p � r <br /> 5. ` /�l�r✓C f L r1 '�• (l/ZP �I rU (D OW or Inn <br /> 0i i <br /> 3 C ' o . 0. xQc. x�Q � m CuNi y > > <br /> 7. <br /> I 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 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <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 �, i U131 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person have access to the above described premises at any reasonable time for the purpose of inspection. <br /> m <br /> SIGN HERE (date) <br /> (Signa re of owner or building c tr ctor) 9 <br /> ZONING ADMINISTRATOR w`A cn fw w w <br /> fNJ1 NO V! NOO <br /> ` O <br /> 000000 00000 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />