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b1uyl <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITSor <br /> 3. <br /> r ( a <br /> OWNER TELEPHONE � ( <br /> �/ TT d V <br /> HOME ADDRESS Alit :j a0? ��V r•� �\ <br /> EMERGENCY/FIRE NUMBER ROAD NAME p <br /> r <br /> LEGAL DESCRIPTION(see tax receipt) ! �S m V/-7 ���3 G} ��t Q —46 co <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION =� 0 <br /> ❑ ❑ TION El PRIW ❑ In <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVIv5i <br /> STRUCTURE/ADDITION USE: C` C( SION / — // <br /> //J n (Home/Cabin; Commercial siness; Bedroom; D k; etc.) a <br /> BUILDING CONTRACTOR: <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/1 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 i <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> � c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) OT o \ <br /> T0 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m X <br /> 2 .SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m \Z_(, <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <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. <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. 'o 00 <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ) <br /> ISSUANCE. l <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. '' 1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY W <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> M 010 4OD <br /> 6. g• � 'May o • 3 <br /> •o N C N -'1 <br /> y NCD <br /> 7. C =M' ;a G <br /> Cn <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my L7 C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o B <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- d <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 <br /> pl�t . : a) : : : <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or othero : <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> CDm <br /> SIGN HERE <br /> (signature caner or building cont t ) (date) <br /> ZONING ADMINISTRATOR <br /> N (n N N Ln CA <br /> 1tn Cn O (n N 00 <br /> O 0 0 0 0 0 0 <br /> 4NSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />