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r <br /> Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 � _ Office of Zoning Administrator - o <br /> APPLICATION FOR LAND USE 3. <br /> C <br /> OWNER 12 c2T— C�- �t r-4' TELEPHONE <br /> HOMEADDRESS j At � Y O <br /> _ I <br /> EMERGENCY4.9jZF NUMBER 2 3(0 L ROAD NAME m <br /> /Q q <br /> LEGAL DESCRIPTION(see tax receipt) L l U 33— ) m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIW ❑ N <br /> 0 <br /> TYPE OF PERMIT(S): it <br /> r FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5 <br /> STRUCTURE/ADDITION USE: C <br /> 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) m <br /> m <br /> BUILDING CONTRACTOR: f <br /> v <br /> Q <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 01 _ <br /> A in W <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o l <br /> -n 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 /> NORTH(N). ca 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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 0 1 <br /> q0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Et <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> V- <br /> 1 DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT C� <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. � vnmv �ov <br /> CD . m m a m <br /> 6' a C. Co" y o 53_ <br /> 7. o: Ngoq <br /> — fn; •� <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G)c c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ()1 m 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 3 E <br /> authorized pe have access to the above described premises at any reasonable time for the purpose of inspection. -n <br /> SIGN HERE � <br /> (slgnatur f owner or building c tractor) (date) <br /> ZONING ADMINISTRATOR <br /> N N P N N P P <br /> P P O P P O O <br /> 6/OWNSHIP PERMITS MAY BE REQUIRED ° 0 0 0 0 0 0 <br /> 0000000 <br />