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ot" C&7e <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> CID APPLICATION FOR LAND USE PERMITS 3. <br /> ^^ r <br /> N � <br /> OWNER / ' G��+/���/ 0 (//, b0a L`EP�E <br /> m <br /> HOME ADDRESS <br /> c;;Z3&n 0— <br /> r m <br /> 0 <br /> EMERGENCY/FIRE NUMBER oS0 7jr7 _ j ^ ROAD NAME ejQQ� <br /> LEGAL DESCRIPTION (see tax receipt) F rCn <br /> n <br /> Q <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTUR ADDITION ❑ PRIVY (1) ° <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING E CAMPING UNIT ❑ SUBDivisiON ❑ <br /> STRUCTURE/ADDITION USE: /903- �aJ170/. / �. <br /> 0 <br /> (Home/Cabin; Commercial Busine ; Bedroom; Deck;etc.)9X 1foT 0) Z!!— r h <br /> BUILDING CONTRACTOR: � X �h�p// i Z v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> rZ1 N � V <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 CL <br /> M <br /> 0 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). tcn <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m � <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF x 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 <br /> BUILDINGS,ROADS,LAKE,LOT LINES. I S <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Ol 1 1,41111 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR,ETC.,THE PLANS N" 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. or <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN � W B <br /> NEEDED. 00 °— <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: U <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT t Q <br /> ISSUANCE. <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 /> V 0 r; N M Da m <br /> m �. N <br /> 6. v Co. C.0No 3 <br /> 7. o <br /> _m : <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my i i7 c i i C <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 1X7�� CIn <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 which may be a result of the County of Burnett relying on this information I am m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other py3 <br /> authorized person .have access to the above described premises at any reasonable time for the purpose of inspection. -n <br /> (D <br /> If jo <br /> m : <br /> SIGN HERE (�� � <br /> sign ure of owne r oildIng contrac or) (date) % <br /> Q <br /> ZONING ADMINISTRATOR <br /> N N oy NU0CA <br /> 0 <br /> (T UtO� TO <br /> TOWNSHIP PERMITS MAY BE REQUIRED ' 0 <br /> O <br /> 0 0 0000 <br />