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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3. ° <br /> o rW`! <br /> OWNER TELEPHONE /O3CX <br /> HOME <br /> ADDRESS9 0 <br /> l � y� C � �p / s VF04 <br /> r m <br /> EMERGENCY/FIRE NUMBER ROAD NAME p <br /> LEGAL DESCRIPTION(see tax receip �► � yvi� CN3 <br /> DWELLING BUILDING IPt GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ N o <br /> TYPE OF PERMIT(S): V <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> N <br /> STRUCTURE/ADDITION USE: fJ C c <br /> ,pp (Home/Cabin; Commercial Business; Bedroom; Deck, etc.) C <br /> BUILDING CONTRACTOR:A/ALI/�JG'Ad7-4 h/ if lI I <br /> CD <br /> I PLOT PLAN MUST BE PROVIDED ET R LEAST AN 6'/:X 11 SHEET OF PA ANY INCOJNPLETE OR _ O 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. J�c.N�n�,�L' IOG,)y,, ,u-/O/!"� � 3 <br /> e <br /> DIRECTIONS FOPLOT PLAN DRAWIN • (AERIAL OR TOP VIEW) ��ti� � f�""`r p m <br /> R e <br /> OC <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. %a��'d� n <br /> NORTHO Z <br /> M `; <br /> 2 THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> ( ) <br /> IZZ <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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. c <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. c 01C <br /> v ) <br /> 9 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q o ^� <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 r� <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 W <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> 5 SETBACK AREA. L <br /> v n rp 0 L <br /> In m <br /> m C 1 " > > 3 <br /> 7. (WD i o <br /> o <br /> =cn m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accur cy of (�+n' m L= c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ` CDm : m <br /> [� . <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whethe to is- � � p <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this informatio I am <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspe tion. <br /> CD <br /> CD <br /> SIGN HERE <br /> sig ature o w r or building contractor) (date) E <br /> ZONING ADMINISTRATOR <br /> N N N N <br /> (!� N P O U7 (n P P <br /> O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED x 0 0 0 0 0 0 <br /> 000000o <br />