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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v 0 Z <br /> APPLICATION FOR LAND USE PERMITS <br /> N <br /> 11 Ae H <br /> )� C7 fNour.( D vora, �" L_ <br /> OWNER TELEPHONE �J F-3-5-13 p <br /> m <br /> HOME ADDRESS <br /> ' r m <br /> EMERGENCY/FIRE NUMBER S M�% ROAD NAME pr o <br /> LEGAL DESCRIPTION (see tax receipt) ociQ � � y <br /> m <br /> 1:1e <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION APRIVY ❑ <br /> TYPE OF PERMIT(S): � <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIV SION ❑ o. <br /> �ct�0iy� — 'QLQ � ir�j/ISTr^fc�yc;?6 I <br /> STRUCTURE/ADDITION USE: � <br /> © (Home/Cabin; Commercial B siness; edro Deck;etc.) rcA rn ^ <br /> r <br /> BUILDING CONTRACTOR E,' <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> 0 H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n n <br /> _n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n Wo :b <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m :° <br /> NORTH(N). <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m0 <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. o <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. Q <br /> S. 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 Y✓ <br /> MUST BE SIGNED AND DATED BY THE OWNER. c <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHENq o _C1NEEDED. C <br /> r. O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: ° ) <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ( Q a <br /> ISSUANCE. 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. V 1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY V <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> sly * <br /> V DrgM � O�O <br /> OIL <br /> M 3 CL(D ' <br /> Z : <br /> o : <br /> =o' : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Ej p <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 (11 Cm m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- h d O <br /> sue a permit. I further accept all liability which may be a result of the Coun Ir,rngtt lyl{{{���on this information I am <br /> providing in this application. I agree to permit county officials chard tll st¢ q ron ordinances or other "-p m E <br /> authorized person to have acc s to the above described pre ises at rty, jS�r e r t �u ose of inspection. -n ' E <br /> m <br /> SIGN HERE <br /> 6 _ O_n <br /> (si natu of owner or it contractor) (date) <br /> ZONING ADMINISTRATOR i <br /> ZONING N cn N N(! (n <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />