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6-)'t G� <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning AdministratoZ <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> CDN <br /> N <br /> C <br /> OWNER cslf,��? TELEPHONE &-5/ 6 7 FV <br /> HOME ADDRESS q53(10 C'edg f- c r e Sf Tra i,/ lfal'r/ s MAS <br /> r � <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME �n ted Z ( ~ <br /> EGAL DESCRIPTION(s a tax receipt) &-r 0 lam �/ (? ��� o "vL 1 ( c <br /> m <br /> n <br /> \� DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIWI?] N <br /> TYPE OF PERMIT(S): v ' <br /> FILLING/GRA ING ❑ CAMPING UNIT SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: Ocf <br /> (Ho /Cabin; Commercial Business; Bedr m; Deck;etc.) rn <br /> PHVdJ <br /> BUILDING CONTRACTOR: -1 <br /> T <br /> TI <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE ORIn <br /> 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 m \ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n a <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m 'A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OFZ <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. CAN <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. `2 f 1 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N (J�► <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS +MUST BE SIGNED AND DATED BY THE OWNER. 'o' °0 1 <br /> O 9 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q <br /> NEEDED. 0 �I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z 91 <br /> CONDITIONS OF PERMIT: P 1D <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT J <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. CA <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER rV <br /> SETBACK AREA. (7j <br /> 5. <br /> Q m r- v O <br /> m <br /> 3amRL ;a <br /> 6. CCv <br /> 7. Z : y Z ` <br /> 0 . In <br /> ( � =m: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my VJ Zj c ID <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofCL <br /> � m 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- 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 m <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other E m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m i f <br /> m <br /> SIGN HERE S- a — li -I <br /> (sign re of owner or builds c tractor) (date) <br /> ZONING ADMINISTRATOR <br /> to 40 to iN to iH <br /> N Nf71NN V1(T <br /> 01 N O N U 1 0 0 <br /> TOWNSHIP PERMITS MA E REQUIRED o 0 0 o c 0000000 <br />