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Burnett Cqunty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator ci Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N 0 <br /> H <br /> OWNER )QAA .g4!5j 4 ND- Fo�C �rJ,��dGF TELEPHONE �S�G_7�/.53 0 <br /> m <br /> I� /� ^a_ / <br /> HOME ADDRESS o��53L �.5�" , �q�— G- � <br /> EMERGENCY/FIRE NUMBER S-PrTYI F ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) A)(Al_ u <br /> l� ) ��_ / V�1 f„ co <br /> l 1[J m /V <br /> C) <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION PRIVY ❑ N 0 <br /> TYPE OF PERMIT(S): cQ <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5 <br /> STRUCTURE/ADDITION USE: fi c <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) w <br /> BUILDING CONTRACTOR: fir <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/]X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 -� <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> �I N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n a <br /> _n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m fD <br /> NORTH(N). <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 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. o <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 I <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q 0 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <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 AREA. <br /> 5. <br /> 0 0) CD rn <br /> 6. COD ` mc10o9' 3 <br /> 7. zE " (OD R 'O -I <br /> o <br /> =y : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Lj c IO <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m 0 S <br /> CL <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have agoss to the ab ve describe5,LKRmises at any reasonable time for the purpose of inspection. T <br /> m : <br /> CD : <br /> SIGN HERE <br /> (signature of nerr rr building contractor) (date) � <br /> ZONING ADMINISTRATOR <br /> cn cn w Fn En Fn <br /> N N fT N N VI Vt <br /> (T CT O fT (lO O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />