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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administra or ' o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> '\ 41 <br /> OWNER r� CSV' ��� ��50� TELEPHONE Fj�t—`Z�Q s — yc ( 2 p \' <br /> HOME ADDRESS a L E- �j bm� Ja ` r`� <br /> 41- <br /> EMERGENCY/FIRE NUMBER 16%9q ROAD NAMESi ve-,Bake R'dcLc� <br /> LEGAL DESCRIPTION(see tax receipt) 1>:4 9/773'&M I 63 /0Cj v ` C/ m <br /> n <br /> 0 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ O c 0 <br /> TYPE OF PERMIT(S): <br /> FILLING/GR <br /> A <br /> D <br /> ING ❑ CAMP I G UNIT 1:1 SUBDIVISION/�❑,, <br /> STRUCTURE/ADDITION USE: (� <br /> I.\ / <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> C V" <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n a <br /> T O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE rn <br /> NORTH(N). ° <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Cod 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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. fV <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. I <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Ct <br /> W <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: �y <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT \Jr <br /> ISSUANCE. u <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. r <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. This structure to be used as private residential <br /> 5. �j1S/7'1 m � mar+ iCCDCL C� m <br /> C (/ garage/storage onl g ` 3 a ° � <br /> 6. habitation. y' Not to be used for human ° " m ° ' 3 <br /> Z °�� ��° <br /> 7 o : <br /> �' rn <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G3C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o I- <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize c" m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is G <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 i m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> �y w <br /> SIGN HERE P'uc <br /> sig ure f o or building contrac (date) <br /> ZONING ADMINISTRATOR \ fnv+w cn En��{���������qq+qqqq+++++ <br /> N N N N(M LnT <br /> 1ppQ <br /> TOWN IP MAY BE REQUIRED PERMITS 00000 <br />