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cyV01)4 <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 /> N O <br /> Il-� (Ii. . �l C.t7t✓lYY1UVl`\ `I Y.U�1Y�C <br /> TELEPHONE 77V <br /> 0 <br /> / l_ N <br /> HOME ADDRESS 2 n l0 Z I H `1 ` T <br /> EMERGENCY/FIRE NUMBER 2 z ROAD NAME COu VJ� <br /> Lvfs l—�/ C5m U"l J 10 na4-4- <br /> -5N� <br /> LEGAL DESCRIPTION (see tax receipt) LO f G U Dl 1 asa —�receipt) ( <br /> j) <br /> c <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION PRIVY ❑ C <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5_ <br /> ' / N, <br /> STRUCTURE/ADDITION USE: W U ( 117 0 <br /> (Hom Cabin; Commercial Business; Bedroom; Deck; etc.) C <br /> BUILDING CONTRACTOR: <br /> v �[ <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 5 ee c /1! <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) _ �/ L / 0 Q fan <br /> +19rF— (/ A o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. opp'l q-I�'G n m :b <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE nn �°NORTH IN). g <br /> I <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m ( vn✓' <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 1! Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ° <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. f <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. <br /> v � � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q <br /> NEEDED. <br /> 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o n <br /> CONDITIONS OF PERMIT: C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT J <br /> ISSUANCE. ILA <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 lJ <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK A A. /_ / y� Nl,�e, y <br /> 5. \�- ,.,F' .6.- ` r/r'7 0.uti ! /- " C. L 1 i1 <br /> C AvnW vv <br /> 6. <br /> 00 <br /> = ' 33 <br /> 7. Pe ✓GG leu ,s /C�^ ' P? c y CQ <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my i i i c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of n.E' <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 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. 1 agree to permit county officials charged with administering county ordinances or other (0 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> CD <br /> �f/ oCJ <br /> SIGN HERE � <br /> (si natu ofoWnerorbuildin tr for ate) a�� � <br /> N <br /> ZONING ADMINISTRATOR ' ' M NIM,C <br /> N CA P N 0 PP <br /> En Cn <br /> 01 VI O N V7 O O <br /> �/OWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 0 <br /> r0000000 <br />