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Y <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator a0 o <br /> APPLICATION FOR LAND USE PERMITS <br /> U o <br /> N <br /> OWNER <br /> Vol TELEPHONE 2 J 3d <br /> \ l �\ fD 0 <br /> HOME ADDRESS `� /�Q� 3 `�C 1Cr�IT a{) (M �`� _ o I g <br /> EMERGENCY/FIRE NUMBER 6" ROAD NAME �a,,J I j� 1��1 <br /> d <br /> LEGAL DESCRIPTION(see tax receipt) /�r7 1 o M <br /> 0 <br /> � <br /> y v. <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE lal ADDITION ❑ PRIVY C o <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5. <br /> STRUCTURE/ADDITION USE: ° <br /> (� (H e/Cabin; Commercial Business; Bedroom; Deck;etc.) m <br /> (� <br /> BUILDING CONTRACTOR: 1C ) 1� C04-;L <br /> 5f <br /> v � <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR ,n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> 0 m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) c <br /> n o. <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <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. 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. 'o c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN o Q <br /> NEEDED. T <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o Q <br /> CONDITIONS OF PERMIT: j \ <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 /> ;o M. w LL <br /> 6. a ` mcm °o� 3 <br /> Z : CMD <br /> 7. o �� .'0 <br /> = r : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o <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- m G <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 to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> m : <br /> a m <br /> SIGN HE }�^ - �-ti ..c d 7 . <br /> ( nature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> _ 6rwwFn F»fn�' <br /> N NfJ1 NNUIN <br /> � no00oo <br /> TOWNSHIP PERMITS MAY BE REQUIRED C G O O C O G <br /> 0000000 <br />