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e4� <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> _ V�4 <br /> a <br /> OWNER T TELEPHONE <br /> m <br /> HOME ADDRESS ) <br /> EMERGENCY/FIRE NUMBERf�2 3V ROAD NAME VEP— <br /> Q <br /> LEGAL DESCRIPTION (see tax receipt) m <br /> S D IVIOA1 / JE' A0 <br /> c <br /> DWELLING/BUILDING ❑ GARAGE/ACC SSORY STRUCTURE XADDITION ❑ PRIVY Cn ° <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n; <br /> / r –� / N <br /> STRUCTURE/ADDITION USE: CCQ� �l �Co� 0 <br /> p/ ((Home/Cabin; Wnmercial Business; Bedroom; Deck; etc.) m <br /> BUILDING CONTRACTOR: CD <br /> v <br /> 1 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> ?I 0 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C <br /> NORTH(N). ° <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. <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. b ,o c <br /> v 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a 0, <br /> NEEDED. T 4--1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c P <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT { `� <br /> ISSUANCE. r <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE.3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY l` <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WA/TEERC��h <br /> 6 SETBACK AREA. ��I / O e A \�4)��V7�( °J' �; <br /> m . N C m m <br /> 6. 1 v ° <br /> N <br /> R N 7,9 <br /> II d�hat this ap lication (including any accompanying schedule) has been examined by me and to the best of my ,c c <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 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 /> C m <br /> that this information I am providing will be relied upon by4,1n ty of Burnett Wisconsin in determining whether to is- Osue a permit. I further accept all liability which may be a of Burnett relying on this information I amproviding in this application. I agr a to permit �iQth`:administering county ordinances or othermauthoriz o ave access the above desc ' ylises n e time for the purp se of inspectionCu <br /> . <br /> m <br /> m : <br /> SIGN HER <br /> gna ure of w r r Ilding cggtract (date) <br /> \ t3 <br /> ZONING ADMIN TRAT . ` ` ` ` ` fA <br /> fq fA fA fA fA fA-' <br /> O/V WWI <br /> N NOINNrru, <br /> ,Y fn NOOi Vf00 <br /> TOW SHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />