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/T co; <br /> 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 /> OWNER 7'q�j2 ,L. v�•L t1sGty� TELEPHONE 7/S <br /> m <br /> HOME ADDRESS (, ,7f" � � ��,� K/(Sr <br /> n°0 <br /> EMERGENCY/FIRE NUMBER f3q ROAD AME /Pa <br /> a 1� <br /> LEGAL DESCRIPTION (see tax receipt) p� � / i in <br /> n <br /> (� <br /> DWELLING/BUILDING El STRUCTURE ADDITION ❑ PRIVY ❑ `1 (n 0 <br /> TYPE OF PERMIT(S): a +! <br /> FILLING/GRADINGq <br /> CA PING U 1T SUBDIVISION ❑�a C` <br /> c. <br /> STRUCTURE/ADDITION USE: O <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) rn <br /> m <br /> BUILDING CONTRACTOR: ECD` <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 /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> -n v <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C <br /> NORTH(N). <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 <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. <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. So <br /> O 9 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q <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. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. I <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 /> CD 00 o <br /> 0 1- Cv <br /> 3 = � aim <br /> 6. m � .o m 0 � 3 <br /> 7. c ' m m '< ° 1 <br /> y X <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ': i S <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CD <br /> M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- t7 <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 O <br /> providing in this application. I agree to pe county officials charged with administering county ordinances or other m <br /> authorized person tp4pve access to t e descr' emis at any reasonable time for the purpose of inspection. m <br /> )z m <br /> SIGN HERE L /✓ �/ <br /> (signa re ownero bu[ding contractor) (date) `A <br /> vP <br /> ZONING ADMINISTRATOR �C/ w <br /> t»to w 'A <br /> N ro 01 01 <br /> N N N tT O O <br /> TOWNS PERMITS MAY BE REQUIRED o 0 0 0 0 <br />