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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v ci Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> M r <br /> N O <br /> C <br /> OWNER j ^� <br /> TELEPHONE���',e 7 /'mMbr <br /> HOME ADDRESS 7/ ` <br /> C"om— tml <br /> v r <br /> EMERGENCY/FIRE NUMBER 7/ Z.5– <br /> ROAD NAME C14 C 1 1 <br /> LEGAL DESCRIPTION (see tax receipt) � y <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ " m 0 <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑`, SUBDIVISION ❑ <br /> �/ / a <br /> STRUCTURE/ADDITION USE: Y`Q`-1 e SAY T)` /t �L� <br /> J �(Home/Cabbiin; Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: V17J k L `1/7 &d,siey'_S <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. (� <br /> .0 N ,lL✓� <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T CL <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 - <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 a <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF \ \ Z <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. V <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 Q <br /> MUST BE SIGNED AND DATED BY THE OWNER. (� o <br /> v � � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z l�✓� <br /> o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT QJ <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 /> :0 -0 C) r OO � <br /> 6. CN " o 3 <br /> 7. Z ' yew : ,off <br /> O : <br /> Cn: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �; p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ` C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize \� M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- O <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 y <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. T <br /> CD : <br /> SIGN HERE <br /> (sigof owl or buildin c�ntra�c-tor) (date) <br /> natu <br /> ZONING ADMINISTRATOR 711-n ' c� d+ <br /> L14 <br /> K) 0 <br /> !M P NN(T0u 0 O OTOWNSHIP PERMITS MAY BE REQUIRED b 00000 <br /> 0000000 <br />