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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator CD <br /> o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N O» <br /> /� TELEPHONE - .r_ L ^p <br /> OWNER L.�C�U�I �C��1y1SC f��C G/�/)/F /1lIL `Xo I IJ�`� 1CGCt� <br /> m 05.1HOME ADDRESS <br /> r � <br /> EMERGENCY/FIRE NUMBER ROAD NAME LOT <br /> (I� <br /> LEGAL DESCRIPTION(see tax receipt) or <br /> �` L. C�fJ'v' <br /> Q <br /> DWELLING/BUILDING L GARAGE/ACCESSORY STRUCTURE El ADDITION 1:1 PRIVY ❑ 3 <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING ❑ CAMPING UNIT 11 SUBDIVISION ❑ S <br /> {{. N <br /> STRUCTURE/ADDITION USE: <br /> ,�{ L (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR:.11 <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 1 �1 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 5 �J' <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) c <br /> 0 ii <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE; m d A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C o <br /> NORTH(N). Cn <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <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 I <br /> BUILDINGS, ROADS,LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 1 fV <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS -4 ` <br /> MUST BE SIGNED AND DATED BY THE OWNER. O 0 XJ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN a r <br /> NEEDED. <br /> Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o Q <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT (� Q <br /> ISSUANCE. •XJ I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER Op <br /> SETBACK AREA. <br /> �/ <br /> 5. /b � vvO� pQ L rn <br /> CL <br /> CD <br /> 6. 9 m C N y 0 <br /> 7. O �y <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my L7 C C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of c E - <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- i���` 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 1J� <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized pe on to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> CD <br /> Ar <br /> SIGN HERE <br /> (dale) <br /> (s ture of wrier building contractor e) <br /> 16A4 <br /> . : 4L9ZONING ADMINISTRATOR �-o K) Ln r)yr d+ <br /> N K) Lnrlppo <br /> Ot 01 0 01 Vt 0 0 <br /> 0000000 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 8o000000 <br />