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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator CD o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N � <br /> N <br /> / / C <br /> OWNER y�f�� �A r lCe r� TELEPHONE 71s—!p Stp—�OlS m \ 00 <br /> HOME ADDRESS 3dOS�c /Vj;N erVA De-Ki Rd DAN burw <br /> f0 <br /> EMERGENCY/FIRE NUMBER 3 00,55 ROAD NAME M1"M4e rV FIM <br /> J'Q P 17WIRII&W <br /> L>Q Co <br /> LEGAL DESCRIPTION (see tax receipt) &4iNsdpy 'sR'v�Vicw�PA-r)< Loi a8 g <br /> DWELLING/BUILDING ;& GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ rn 0 _ <br /> C <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> 5. <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: �� f <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/1 X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 U <br /> c \M <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) <br /> T o. <br /> :E! O 1 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 9 3u <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE 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 Z <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. W <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS n �� Sn ` <br /> MUST BE SIGNED AND DATED BY THE OWNER. V✓ Rio' XIJ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q 0 <br /> NEEDED. <br /> Z <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. J) <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY �U"1 <br /> PERMITTED. <br /> r� <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA <br /> 5. 4 mM. mn CDCL R <br /> F--� 8453CLM RL ymo� 3 <br /> 6. <br /> N O O <br /> P w :n,< ' <br /> 7. _ (n : <br /> n <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my [7 <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of E <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CD <br /> M . C <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. - <br /> it <br /> SIGN HERE <� <br /> ature of owner r\Ilding contra ate) <br /> M <br /> ZONING ADMINISTRATOR < d+40 <br /> N N V1NN0 (T <br /> � CnOUt (TOO <br /> t�,l'✓I'E�o(TY� 0 0 0 0 0 0 0 <br /> TOW IP PERMITS MAY BE REQUIRED <br />