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Burnett County 7410 Co. kd. K, No. 102, Siren,WI 54872 Office of Zoning Administratoro 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N <br /> UI 4- <br /> C <br /> OWNER Q C ����� TELEPHONE 3227 o t <br /> HOME ADDRESS <br /> N m <br /> V <br /> J <br /> EMERGENCY/FIRE NUMBER �� 4114 ROAD NAME <br /> ( <br /> LEGAL DESCRIPTION(see tax receipt) Pct ftu, ��� V � 3 r'yoN-R Is Li Cn <br /> J 0 <br /> DWELLING/BUILDING 1:1GARAGE/ACCESSORY STRUCTURE ❑ ADDITION LVJ PRIVY ❑ fn <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑ CAMPING/U�NIT�❑ SUBDIVISION ❑ m <br /> STRUCTURE/ADDITION USE: �CaVh Q. f ii7FJ��1 L DI`/ <br /> (� C (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) U <br /> BUILDING CONTRACTOR: \`® `w t��G <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHE T OF PAPER. ANY+INNVPS T��jt�� � N <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. SCe SA N�TLe—(f� <br /> h�_ �/M� Z` p <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEN/) Zv Intn10-3-00 n <br /> ue c <br /> o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OWN TO SCALE. z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m n <br /> NORTH 3. SHOW D M)ENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT-LINES,(B)BUILDING(S)TO m 3 <br /> P <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. c <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 f <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q ° 'C <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o r <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ()) <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 REA/ <br /> s. gm <br /> 6. 117.1/1 ,G1 w"2-Q /cx.-. .G��� m a y <br /> COD C (I1 O J <br /> Z : H (WD <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c 10 <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o V, <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m 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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m : <br /> authorized person o have access to the above described premises at any reasonable time for the purpose of inspection. -n <br /> m : <br /> SIGN HERE A <br /> (signature ofo ne or building contract (date) <br /> ZONING ADMINISTRATOR ' <br /> �4A �� <br /> NMNI C (T <br /> N M O N V 1 O O <br /> TO SHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />