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Burnett 'ounty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N 0 <br /> W <br /> C <br /> [1 <br /> OWNEQ�j-�/�"'� ,LJ(��j���,e� TELEPHONE <br /> HOME ADDRESS p� D C� Ay�i 21 led <br /> EMERGENCY/FIRE NUMBER ROAD NAME I <br /> l� <br /> LEGAL DESCRIPTION (see tax receipt) ��— �(�—�7 &L 6/ m <br /> 7 1 1 N <br /> 0 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ � � <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAM G UNIT ❑ SUBDIVISIO ❑ a <br /> 'p / N <br /> STRUCTURE/ADDITION USE: CSI�Y) U�2 �(OQ— I 0 <br /> / (Home/Cabin; Commercial Business; Bedroom; <br /> DD k;etc.) C <br /> BUILDING CONTRACTOR: t /I�1 P �' y/ �L[ ✓ fi \I <br /> 1 <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR -r! B <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 ii <br /> ?� O Z <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 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 1 v <br /> Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ° <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. v C <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Cr S Gee <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 Q� ) <br /> ISSUANCE. (1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. JJ <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 /> A � nr CD q <br /> (m < 3 CK R('�a an d <br /> N G W N - <br /> 6. m W W o w <br /> 7. <br /> OZ G <br /> IO <br /> m C7 <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 n L C <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- <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 4� 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 /> m : <br /> SIGN HERE i <br /> (signat re of owner or buI!SVnjq contractor) (date) <br /> ZONING ADMINISTRATOR4 <br /> teteN MCA <br /> N <br /> N 010 NN NO <br /> V7 O Vt V700 <br /> O 00 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />