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0 �_ <br /> Office of Zoning Admini�or - a Z <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 3 a ° <br /> APPLICATION FOR LAND USE PERMITS y <br /> n e b <br /> I TELEPHONE 7/6- 327 81Q0 o S <br /> OWNER �lLiAPI /V Bf1RT«� O <br /> HOME ADDRESS 111116 00M <br /> / ROAD NAME FArrWM 1ARE /c <br /> EMERGENCY/FIRE NUMBER _ <br /> LEGAL DESCRIPTION (see tax receipt)S <br /> PT O <br /> c <br /> DWELLING/BUILDING LJ <br /> GARAGE/ACCESSORY STRUCTURE ADDITION , PRIVY <br /> o. <br /> TYPE OF PERMIT(S) <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISIONEI o2o00 SMA <br /> STRUCTURE/ADDITION USE:-- (Home/Cabin; CommerciaY-business; Bedroom;Deck; c.) �, <br /> BUILDING CONTRACTOR: <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> 0 3 <br /> O <br /> ILLEGIB ANS WILL BE RETURNED. M w <br /> O a <br /> IRECTIONS FOR PLOT PLAN DRAWING: ( ERIAL OR TOP VIEW) n v z <br /> <7 m � <br /> M 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE N O <br /> NORTH(N)• m <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF o <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 ` N <br /> BUILDINGS,ROADS,LAKE,LOT LINES. o <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. WI <br /> O <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLA <br /> NS <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE V� <br /> I 2 <br /> NEEDED. l o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. DEC ,rr,,,� <br /> CONDITIONS OF PERMIT: �� w <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS"%TT 'CDUr4TY <br /> ISSUANCE. •" I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORFZM�NG <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. > v n v m <br /> O <br /> 6. o N 2l rmn <br /> c <br /> 7. C7 C C <br /> schedule has been examined by me and to the best of my <br /> I declare that this application (including any accompanying ) F, m <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m v <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize <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. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am <br /> providing in this application. I agree to permit county officials charged with administering county ordinances a other <br /> m ; <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> )� .f'.A.vlc� <br /> (date) <br /> SIGN HERE xJ <br /> (signature of o e r b I a a <br /> o <br /> ZONING ADMINISTRATOR C' <br /> TOW SHIP PERMITS MAY BE REQUIRED <br />