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Burnett C3unty 7410 Co. Rd.K, No. 102, Siren,WI 548726 � <br /> Office of Zoning Administrator , <br /> APPLICATION FOR LAND USE PERMITS 3 4 <br /> 0 <br /> OWNER TELEPHONE 650y- 6(13— <t, <br /> HOME ADDRESS Z,— r�x 4c — /1 , 8�� ' 0� <br /> EMERGENCY/FIRE NUMBERS /2 O L`RQ NAME 1 <br /> LEGAL DESCRIPTION(see tax receipt) L �3 �r CS ? //a P16 � I� e <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION c <br /> S. <br /> STRUCTURE/ADDITION USE: CSit!/ (,— 0 p s <br /> (Home/Cabin; CommercialBusiness; Bedroom;Deck;etc.) rn t� <br /> ,9 m <br /> BUILDING CONTRACTOR: a�/I JI <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> 71 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p <br /> m <br /> o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. z� <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 9 <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m y� 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OH <br /> WM)OF \ Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. o <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. Q <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. c 1 • <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHENq a <br /> NEEDED. C <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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 THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> X 170r- 0 0 <br /> = d ; m m <br /> 9 mCSS 053_ <br /> o <br /> =y <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c : . m <br /> i : C) <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy ofm 0 : C <br /> 9 information contained in this application(including any accompanying schedule)and I further declare that I recognize C ;a <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m p <br /> permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am W m' <br /> "i in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> person to have access to the above described premises at any reasonable time for the purpose of Inspection. <br /> CD : <br /> (signat re of owner or building contractor) (date) . <br /> N N(A N N IA N <br /> V1 N O(71(A00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />