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6/1C't� <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 /> T <br /> H <br /> ���J' C <br /> OWNER �/' '1�' �C'��/ TELEPHONE i97q o. <br /> I o <br /> m <br /> HOME ADDRESS 3778 <br /> r m <br /> EMERGENCY/FIRE NUMBER ROAD NAME 114 <br /> Ij qQ p\ Cur-, <br /> LEGAL DESCRIPTION(see tax receipt) SSE c 3 C`T J4co (tel <br /> oVc� <br /> CD <br /> DWELLINGIBUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ I y <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING ElCAMPING UNIT ❑ SUBDIVISION ❑ 5 <br /> N <br /> STRUCTURE/ADDITION USE: Y 0 `J,() <br /> —� <br /> (Home/Cabin; Confirriercial Business; Bedroom; Deck;etc.) C , 1 1 <br /> BUILDING CONTRACTOR: I tC l /5Y1S1 6�UCT�'a�`- fii IJV <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. O <br /> � c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) OT a <br /> -n v 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 V <br /> C (l <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m JnJ 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF xJ 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. C <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 ) <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN Cr <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 1 �� <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 C� <br /> PERMITTED. NIJ <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> p = nr v?vv <br /> 7. o _y` i m <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my E5 p <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of n 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- Q: ; m '• 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 o: <br /> providing in this application. I agree to ermit county cials charged with administering county ordinances or other m <br /> authorized person to have access to t_Wabgwe des premises at any reasonable time for the purpose of Inspection. <br /> m : <br /> CD : <br /> /2 2 A <br /> 40 <br /> SIGN HERE <br /> (signatureof ownerorbuilding contractor) (date) <br /> ZONING ADMINISTRATOR ' ' ` ' '^ <br /> N NV N VIN <br /> Vt Vt O Vt O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />