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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 O o <br /> CD APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> OWNER 1 Yy -�-- 1 ( - TELEPHONE <br /> HOME ADDRESSCD <br /> EMERGENCY/FIRE NUMBER ROAD NAME I" \ Z�C <br /> loft l ) bout' I ot- I , G5 W) Vo� I�" "e- <br /> PIC <br /> e I�� <br /> LEGAL DESCRIPTION(see tax receipt) m <br /> 0 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY m 0 <br /> TYPE OF PERMIT(S): Cr <br /> a <br /> FILLING/GRADING ❑ CAMPING UNI❑ SU 1VISION El CLS. <br /> N <br /> "/rJ <br /> STRUCTURE/ADDITION USE: r 0 <br /> (Home/Cabin,Comr0rcial Business; Bedroom; Deck;etc.) C <br /> BUILDING CONTRACTOR: 5i <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 17 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 (� <br /> � c v <br /> ERIAL OR TOP VIEW) O o <br /> ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). y 3 <br /> SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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. <br /> SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO ( � <br /> BUILDINGS, ROADS,LAKE, LOT LINES. " 1 <br /> INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR,ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. f'o <br /> o � � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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. <br /> Oro po � o � <br /> m 3 a YYco `s e M <br /> 6. <br /> 7. o <br /> —y ; <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Lj C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofc 0 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize mCDm <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m v <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 E m <br /> authorized person to have access to the above described premi es at any roasonable time for the purpose of inspection. -n <br /> CDCD : <br /> r 40 <br /> SIGN HER <br /> ( X LO-0 <br /> signat a of nor or buildingcontr t ) (date) <br /> t <br /> ZONING ADMINISTRATOR <br /> Fn(nfnd+w0 <br /> N)(A NN VI 0 <br /> P CI CA Cn 00 <br /> TO SHIP PERMITS MAYBE REQUIRED o o 0 o 0 0 <br /> 000000 <br />