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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 0 z <br /> APPLICATION FOR LAND USE PERMITS 3. T <br /> / <br /> OWNER Q LU e r TELEPHONE A 4V <br /> y i <br /> m `�+ <br /> M / � O <br /> HOME ADDRESS ///gip / 12iv� A �ri C LRJ iSC <br /> y r � <br /> EMERGENCY/FIRE NUMBER N O V -e ROAD NAME <br /> tI,I <br /> LEGAL DESCRIPTIONt) L see tax receipt) m <br /> ( p / C�Srn ✓� Pl�� -3e- is ( C <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ Cn 0 <br /> TYPE OF PERMIT(S): Q ' <br /> FILLING/GRADING ❑ CAMPING UNIT ® SUBDIVISION ❑ c <br /> CL <br /> STRUCTURE/ADDITION USE: / <br /> 0 <br /> Home/Cabin; Commercial B siness; Bedroom;Deck;etc.) m <br /> BUILDING CONTRACTOR: [v <br /> v � <br /> m <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. <br /> ;a W <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o �O <br /> m z <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 <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <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. �? <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. ,3 I <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHENa S Il <br /> NEEDED. 5L lJ <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. U) <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Il <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY B , <br /> PERMITTED. CJ <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> mem ? CP ppm <br /> ay <br /> 6. <br /> LV CDCmos3 <br /> 7. V vv V 2 �^ mo 19 �E <br /> ° 01 M <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by mea of my L7 c p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible?tail and cy of n- c <br /> all information contained in this application(including any accompanying schedule)and I fu �e t I recogni m m M <br /> M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in de o i `N4 O <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying o� mat am y 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. -n <br /> CD <br /> ,�t1 <br /> m <br /> SIGN HER �� 4<- Apr . � - OCA � <br /> (signatue f owner or building c n actor) (date) <br /> ZONING ADMINISTRATOR =2 ^ . : • • . w <br /> to Fn Fn Fn w fn <br /> N NtnNNfn (n <br /> N (! O N NOO <br /> OWNSHIP PERMITS MAY BE REQUIRED CD c o 0000a <br />