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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator � o <br /> APPLICATION FOR LAND USE PERMITS <br /> N <br /> OWNEReVTELEPHONE <br /> lj <br /> a G� <br /> HOME ADDRESS <br /> o <br /> EMERGENCY/FIRE NUMBER 310 3� �� ROAD NAME— �Z`J�r2,� <br /> LEGAL DESCRIPTION(see tax receipt) ��M VOI 2 �(o (t t�'Z O��G1 N <br /> Y m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION PRIVY ❑ N o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 2: <br /> m; <br /> STRUCTURE/ADDITION USE: Cab\r\ 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) rn p6 <br /> BUILDING CONTRACTOR: i"'�CnMf Q.J`-1P_' 6— <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> XI N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m C° <br /> n C- <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m jp <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m !P <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 CO) v <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. o <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 CDP <br /> MUST BE SIGNED AND DATED BY THE OWNER. 10' o OOO <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 \ <br /> NEEDED. x� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> 0 1 <br /> CONDITIONS OF PERMIT: Q. <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 /> 6. � tS V L4 ml Ix Llt ;u <br /> mcm � ' 3 <br /> 7. M oz s ^ CD � -I <br /> : <br /> [ �: ;a <br /> I declare that this application (including any accompanying schedul has been examiJn�e e a o the best of my 2 IS <br /> knowledge and belief it is true,correct and complete. I acknowledge t III �I 2S I for the d it and accuracy of a C <br /> all information contained in this application(including any accompany il `S ) ( T*clare that I recognize ol m M <br /> that this information I am providing will be relied upon by the County of Burne In determining whether to is- O <br /> sue a permit. I further accept all liability which may be a result of the County of Bur�n�er�elying on this information I am d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to thea ve d scribed premises at any reasonable time for the purpose of inspection. T <br /> CD <br /> m <br /> SIGN HERE .2�5 O� <br /> (si atur of owne b ding contractor) ( ate) `n <br /> ZONING ADMINISTRATOR OV 1. . . . . . d, <br /> w(n in(H fn(» <br /> N NCA NN (n(T <br /> ' U1 U1 O V1 VI O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />