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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -CD o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> 4 <br /> d <br /> OWNER D l`C - TELEPHONE 7/�LA� o <br /> 0 <br /> HOME ADDRESS x <br /> EMERGENCY/FIRE NUMBER �)� ��Q ROAD NAME ! Z <br /> LEGAL DESCRIPTION(see tax receipt)L �� ,/�Wr LL/ m <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑/oC (n ° <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADI G ❑ CHAMPING UNIT ❑ SUBDIVISIOJAI <br /> <' <br /> STRUCTURE/ADDITION USE: <br /> � c GCS y: <br /> (Home/Cabin; <br /> CComm�errcialusinnes; Bedroom; Deck; etc.) m w <br /> BUILDING CONTRACTOR: IO�Yw Ltd//'�C 1�J Dic, u <br /> m <br /> CD <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. p <br /> M c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n O <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 <br /> C (� <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m B <br /> 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. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO t <br /> BUILDINGS,ROADS,LAKE, LOT LINES. fit` <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <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. oG <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN 0 ° J <br /> NEEDED. q 6-rnI <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o i l <br /> CONDITIONS OF PERMIT: O <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 /> v My C 0, DODcv <br /> 6. m 3 n w F n T. ;0 <br /> Zy N O : o <br /> 7. O 7i� <br /> - C/) : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my L) c C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ° m0 <br /> that this information I am providing will be relied upon b he County of Burnett Wisconsin in determining whether to is- <br /> sue a permit. I further accept all liability which may b result of the County of Burnett relying on this information I am m <br /> providing in this applicall Iagree to permit co officials charIged with administering county ordinances or other <br /> a CD <br /> authorized person to h access to the above d bed premises_pt any reasonable time for the purpose of inspection. -n <br /> CD <br /> SIGN HERE <br /> (signa re ner or buildi tractor) (date) <br /> ZONING ADMI ATOR <br /> 100, <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />