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R" <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. Q , <br /> T 0 7 <br /> � n V l <br /> OWNER t d/ TELEPHONE <br /> HOME ADDRESS /} / <br /> [S� C,botiIV <br /> EMERGENCY/FIRE NUMBERV 7 JGO ROAD NAME L, <br /> LEGAL DESCRIPTION(see tax receipt) / et L/ c— C <br /> J , o <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ O c 0 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ ^.,�.,5 _ ^ <br /> STRUCTURE/ADDITION USE: CK 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) Cn <br /> BUILDING CONTRACTOR: yeti ' <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 61/s X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n ^ p <br /> x N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> -n 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 C fF <br /> n <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 tiZ <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 9 <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. O N C <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. 0 6 <br /> O � t <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> o �\ <br /> NEEDED. <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 <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY QD <br /> PERMITTED. r <br /> 5. NO ST UCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN,,, 11 <br /> SETBACK AREA. �V v I <br /> ;a nv� Ov <br /> 6. �jlfl 2 �UUt CD <br /> 3 o,0Ox 24 <br /> 9 m C o 3 <br /> 7. Z : � CMD <br /> < <br /> BURNETT COUNTY o :W : m <br /> I declare that this application (including any accompanying schedule) has been examined UZN#( the best of my3 c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o 0 C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m [ im <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- O <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 Co <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m ? `: <br /> �> m <br /> M : <br /> SIGN HERE, ��Z i <br /> (signature of owner or bui 1 o tr at ), Q i1 <br /> ZONING ADMINISTRATOR /`' ` to <br /> N N(T NN (n UI <br /> a3d-=?d vvouuoo <br /> TOWNSHI PERMITS MAY BE REQUIRED �v <br /> 0000000 <br />