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Office of Zoning Administrator CIDo° Z <br /> Burnett<ounty 7410 Co. Rd. K, No. 102, Siren,WI 54872 3 0 o <br /> APPLICATION FOR LAND USE PERMITS y <br /> ICL <br /> O <br /> TELEPHONE(oS I- Q a,�C, (( o <br /> OWNER `J !CAI C \ , e 1Tr1 Me'Ci\'C\ .�.. O <br /> HOME ADDRESS�S'bd� "� `iVY�? �`�` `_nk� \ • 0 <br /> ROAD NAME <br /> EMERGENCY/FIRE NUMBER�$ 11 <br /> oa7o 0 Go\► l-o fi 5� y <br /> LEGAL DESCRIPTION(see tax receipt) �, <br /> c <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION �I PRIVY U Cr <br /> TYPE OF PERMIT(S): FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> o' <br /> STRUCTUREIADDITION USE: N <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) m <br /> M. <br /> BUILDING CONTRACTOR: v <br /> m <br /> m 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'h X 11 SHEET OF PAPER. ANY INCOMPLETE OR 0 m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> CL <br /> rTIONS cr,R PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) M Z <br /> DIREm <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. M o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE BUILDING(S)TO m v <br /> NORTH(N)• T OF THE \Z <br /> 3 SHOW CENTERLINE OFF ROAD,CE BUILD NG(S)MEASUREMENT TO THEORDINARYHIGH WATERMARK(OHWM)OF U�o <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 1 <br /> D ALL DISTANCES TO <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AN \ N <br /> BUILDINGS,ROADS,LAKE, LOT LINES. o <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. O ?, o Q <br /> ETC.,THE PLANS <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, to <br /> \ <br /> MUST BE SIGNED AND DATED BY THE OWNER. ,� <br /> W <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q o <br /> NEEDED. Z <br /> 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <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. N ` ' <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> ING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> 4. NO STRUCTURES, INCLUD <br /> SETBACK AREA. v 0? iiu g m <br /> 9 ON O to <br /> 6. o : MM <br /> -U) m <br /> 7. <br /> has been examined by me and to the best of my <br /> schedule <br /> 1 declare that this application (including any accompanying ) <br /> m m ; E <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 it this application(including any accompanying schedule)and I further declare that I recognize k , <br /> the Count of Burnett Wisconsin in determining whether to is- W o <br /> that this information I am providing will be relied upon by Y m . <br /> sue a permit. I <br /> in this further accept <br /> Ill I)reelity which rto permk county officials alsnay be a result ocharged with admf the county of inistteringlcountytordinancestor other <br /> P � : <br /> authorized person to ave cess t the abo escribed premises at any reasonable time for the purpose of inspection. C <br /> SIGN HERE (date) <br /> s gnature of n or building contractor <br /> J <br /> ZONING ADMINISTRATOR o 91 o v,v, 0 0 <br /> TOW HIP PERMITS MAY BE REQUIRED <br />