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r . „ <br /> OX'CZrnjo <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - 0 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> N O <br /> p 2 C. <br /> OWNER LInda, l� TELEPHONE ` ~J$S v d <br /> HOME ADDRESS T�� v <br /> PC�x cq��i��IrU / 5 <br /> EMERGENCY/FIRE NUMBER 3t 17 3 ROAD NAME V S' <br /> i <br /> w <br /> LEGAL DESCRIPTION(see tax receipt) / ur <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION PRIVY El N <br /> TYPE OF PERMIT(S): � p f <br /> ❑ AM S. <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUB IVIS'�°> a <br /> STRUCTURE/ADDITION USE: C ��Q� �� lTSL/_ d�Y / JC /T 0 <br /> (Home/Cabin; Com ercial Business; Bedroom;Deck; <br /> BUILDING CONTRACTOR: 4 fir <br /> v <br /> m <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. 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O c <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m L" <br /> NORTH(N). y 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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. 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. /J <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 U; <br /> MUST BE SIGNED AND DATED BY THE OWNER. to o <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q 0 <br /> NEEDED. adA, <br /> VV <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Zo <br /> CONDITIONS OF PERMIT: CP <br /> (� I <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. CIO <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> = d� CD m <br /> 6. 3 C.� Q <br /> N C N O <br /> ' J <br /> 7. C N am fC <br /> 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: d C <br /> : n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- y 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 m E <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to howe accesso above described premises at any reasonable time for the purpose of Inspection. CD <br /> m <br /> GJ40 <br /> SIGN HE r Ian- / / y <br /> gna re of o e r building contractor) (date) /n <br /> ZONING ADMINISTRATOR to <br /> tnwwwtn tn- <br /> N N N N 91 P O <br /> ut PO VI Vt O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br /> 0000000 <br />