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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator o 0 <br /> APPLICATION FOR LAND USE PERMITS 3CD <br /> . <br /> / N <br /> 0,(J��2 �/YS /f� - TELEPHONE <br /> OWNER ' 117 � 0 <br /> m <br /> HOME ADDRESS <br /> r m <br /> EMERGENCY/FIRE NUMBER �0 /��' ROAD NAME <br /> N <br /> LEGAL DESCRIPTION (see tax receipt) - 'f m CP <br /> -'Ire Z4J l0 <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ (O m� 0 ^( <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING ❑ CAMVqG 941T ❑ SUBDIVISION ❑ 2' <br /> STRUCTURE/ADDITION USE: 0 1' <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) m <br /> L� <br /> a <br /> BUILDING CONTRACTOR: 1 Z <br /> m <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O � <br /> A y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 4 0 Z <br /> In <br /> ro <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> CD <br /> NORTH(N). N 1)Jo <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m ((pp' \ 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Gf Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 0 <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. t <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. IN n ' <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS ( oCD <br /> 7J <br /> MUST BE SIGNED AND DATED BY THE OWNER. '0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z (� <br /> CONDITIONS OF PERMIT: 0 <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. A <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQ A <br /> SETBACK AREA. <br /> 5. 7/j'JQQ��L/ v�,jw,t_� C v CD 0 0 v v �M CL m <br /> 6. ((JJ CD <br /> (D CCD <br /> y N O <br /> 7. O T �1 <br /> U, m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G, A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize ' <br /> PP ( 9 Y ) 9 D CD p <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> sue a permit. 1 further accept all liability hich may be a result of the County of Burnett relying on this information I am ° <br /> providing in this appli qn. I agree t 'p mit cou y officials charged with administering county ordinances or other <br /> CD <br /> authorized person t access tot a ve ibed premises at any reasonable time for the purpose of inspection. m <br /> CDCD : <br /> SIGN HERIfk A&'e-zc' C � <br /> 14 (signature of ownerr ilding contra r) (date) <br /> ZONING ADMINISTRATOR �a—✓V—© <br /> 1. <br /> T N'ZHIP PERMITS MAY BE REQUIRED` <br /> V <br />