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'Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N � <br /> N � <br /> OWNER J R0 TELEPHONE - ^SS 7 O <br /> m <br /> G a- a CDo <br /> HOME ADDRESS <br /> r m <br /> EMERGENCY/FIRE NUMBER f ROAD NAME <br /> Cam I <br /> LEGAL DESCRIPTION(see tax receipt) crop f) V C <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE 00 ADDITION ❑ PRIVY ) rA <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: DP c- — �/TGt✓tOf f r-,g (�cl N l� w 1 14✓IGrf <br /> (Home/Cabin; Comm rcial Business; edroom; Deck;etc.) y <br /> Q m <br /> BUILDING CONTRACTOR: DV r _J R n / P U L Cr r i S fruC �t O 11 Eu Irr 1 <br /> v <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. 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). CA v 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO rn 3 <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. UC) P <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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q E <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. t <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 TKE REQUIRED WATER QN <br /> SETBACK AREA. ; <br /> 5. �,^ <br /> d <br /> 6. we70 <br /> 7. q o y � ' z <br /> !/ _m : ' : m <br /> I declare that this application (including any accompanying schedule) has b mined gy to the e t of my p <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am re for th�' il and.�c/curacy of \ n C <br /> all information contained in this application(including any accompanying schedule) r declare t #I ecognize `!f ' CD rr ; ' M <br /> M <br /> that this Information I am providing will be relied upon by the County of Burnett Wil n whether to is- 00 G <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett on I nfdrtnation I am m E <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 thq above described premises at any reasonable time for the purpose of inspection. <br /> CD <br /> o : <br /> � <br /> JA <br /> SIGN HERE \ —z/7 <br /> —?Z <br /> (signature ow or building co ctor) (date) <br /> ZONING ADMINISTRATOR w <br /> to to to to fA(N <br /> N NLN NN UI <br /> M (n 0 (71(A 00 <br /> �/OW'NSHIP PERMITS MAY BE REQUIRED \ 0 0 0 0 0 0 0 <br />