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_ C� CAD-s <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0CD c o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> .. r <br /> CDN <br /> G <br /> OWNER C a r-leS L-/r /AVAJ. / ' D //'10)— TELEPHONE <br /> HOME ADDRESS 2 Z 7 77 `104 <br /> 0 <br /> EMERGENCY/FIRE NUMBER Z 7 ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) L CSm y C P G L — 3 1 tJ <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE X ADDITION ❑ PRIVY ❑ uJ <br /> o <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISIONVr— <br /> ❑ 5 <br /> //� m <br /> STRUCTURE/ADDITION USE: (lJ X 0 0 <br /> 1 1 <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) rn <br /> BUILDING CONTRACTOR: Er <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> /� N IVl1 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) Om c v_ BVI <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 c a <br /> NORTH(N). N <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO mkaj 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF \ p <br /> 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. 64 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. 1c o <br /> C) <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Cr <br /> NEEDED. T <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: (� <br /> I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT — I <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 C I <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RET INING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> 6. 1TBACK AREA. / D% 7eLI Q/ / r <br /> d� `�° m <br /> s.,. v � Cm o5 = <br /> 7. flame qje- gtp7e_ e{vs x) 664 �d llnekAt-eT ie-Si1� eerCe �Y�(c o " �� ?'P z <br /> -Cn m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to tfie best of my 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 C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CDm m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m l7 <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. TCD <br /> FE <br /> m . <br /> SIGN HERE <br /> (signal re f ner r Ilding n tor) (date <br /> ZONING ADMINISTRATOR 5 ' ` ' ' . <br /> cn to v+m 4n w <br /> N N01 N NMut <br /> (Jt ut OL" Vn OO <br /> O 0 0 0 0 0 0 <br /> OWNSHIP PERMITS MAY BE REQUIRED O o 0 0 0 0 0 <br />