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r <br /> Burnett Ccaunty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v 0z <br /> APPLICATION FOR LAND USE PERMITS 3 °1� <br /> i 1 C TE EPHONE / m <br /> SO <br /> OWNER 1C,i'LI4Vt� � I�IrO�d � CJS �OIZS G � � CL <br /> � � ; <br /> HOME ADDRESS "L I ?�b y r,���4114 0,$ <br /> CQD A v} � `v <br /> ~ r m <br /> EMERGENCY/FIRE NUMBER )OjTpj l4 j FO2 ROAD NAME —] O <br /> LEGAL DESCRIPTION (see tax receipt) 0 <br /> CD <br /> DWELLING/BUILDING ® GARAGE/ACCESSORY STRUCTURE ❑ ADDITION c o <br /> TYPE OF PERMIT(S): ❑ PRIVY ❑ 0 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ // 1 fCL <br /> STRUCTURE/ADDITION USE: � (,Ci.� % <br /> (Home/Cabin;Commercial Business; Bedroo ; Deck;etc.) y <br /> BUILDING CONTRACTOR: ►VvL t SP '� <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8Y:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3! <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 3 <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p <br /> n a <br /> T o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 9 <br /> NORTH(N). C \ 0 <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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. C • 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. <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 IJ <br /> MUST BE SIGNED AND DATED BY THE OWNER. S> > o <br /> o uj <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q o () 1 <br /> NEEDED. tjjryYll <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 r . 4— <br /> ISUANCE. �J <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. '' <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 1N <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER C <br /> SETBACK AREA. <br /> 30 a <br /> 6. CD rn <br /> 7. <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my t3 c p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- p <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 applicatio I agree to permit coy officials char d with administering county ordinances or other a <br /> authorized person toCD <br /> ac ss t he a e desc ed premises any reasonable time for the purpose of Inspection. <br /> SSs <br /> SIGN HERE <br /> sign ure of ow (ding c ctor) (date <br /> ZONING ADMINISTRATOR /J <br /> N NNNNNy� <br /> flf N O Vt Vl O O <br /> TOWNSHIP P MITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />