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A Ga>-7'r�o <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - 0 0 <br /> CD APPLICATION FOR LAND USE PERMITS 3. <br /> .' TO 1.4b .14T if. m r <br /> OWNER /, TELEPHON&OA3.Y-- L/�7� O <br /> HOME ADDRESS �� �� , �fC- L��lt f/ / S��Ob� v <br /> r pv <br /> EMERGENCY/FIRE NUMBER 3 ROAD NAME lf l,4,oee T a <br /> LEGAL DESCRIPTION(see tax receipt) in <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION PRIVY _ZcNqlis. <br /> c <br /> TYPE OF PERMIT(S): c <br /> ❑ C PING UNIT ❑ SUBDIVISION ❑ a <br /> FILLING/GRADING Q� <br /> STRUCTURE/ADDITION USE: A f,r/ �� �—T/(� �U n� 0 <br /> (Home/Cabin; Commercial Business; Bedroom;Deck; etc.) m <br /> BUILDING CONTRACTOR: trit. <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. T - <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n o- <br /> _n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C7 m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). y c <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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. P <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. d N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 1 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. .� o <br /> opo � 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHENq 0 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: 0 <br /> l <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT l (� <br /> ISSUANCE. 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 TH R QUIRED WATER <br /> SETBACK AREA.5. �LF� / � C�`.�� /�p � <br /> m �• 0) m m <br /> 6. ion o_N %a M <br /> N C N <br /> 7. Z !" �1< i <br /> JO <br /> it <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 13 c m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of C c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> IT <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. agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to h vealw6ess to the abovedeacTibed premises at any reasonable time for the purpose qrf ins ction. m <br /> o : <br /> SIGN HERE r � • • <br /> (signatu e r ng contractor) (date)(� <br /> ZONING ADMINISTRATORIN <br /> wtncntn <br /> N NON "CnN (T <br /> Ut fTOfT Vt 00 <br /> OWNSHIP PERMITS MAY BE REQUIRED <br />