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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. p <br /> 0 <br /> N O <br /> OWNER �"/1 �'/ W• sIP E/"N, Nei SC N TELEPHONE �/-� 1f6-7 9P/7 y <br /> HOME ADDRESS � <br /> EMERGENCY/FIRE NUMBER ROAD NAME' <br /> /3 VAV)�N7`(�tr0� C U <br /> LEGAL DESCRIPTION(see tax receipt) j � S— ��� .(� JD� <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ ur <br /> TYPE OF PERMIT(S): C <br /> Cr <br /> CL <br /> FILLING/GRADIN CAMPING UNIT ❑ SUBDIVISION Z <br /> STRUCTURE/ADDITION USE: _ <br /> ( me/Cabin; Commercial Business; Bedroom; Deck;etc.) d "k�r d <br /> BUILDING CONTRACTOR: > E <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/z X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3. <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. [ 9 9 ,-Tf= 6 y W <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0c <br /> n n <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m X <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m + 3 <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. I c <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. I <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS LF <br /> MUST BE SIGNED AND DATED BY THE OWNER. J <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q ° O <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ()\ <br /> ISSUANCE. �J <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY CS <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. -Z. <br /> 5. ;a -0 0 r.-�, 0 -0 <br /> m M. m d m <br /> o <br /> 6. v mC:WWW �o- <br /> � nR ''° -1 <br /> o ZM*< : <br /> �. = c' j m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ? a ff - <br /> CD <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize C^ <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- �: w 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. I agree to permit county officials charged with administering county ordinances or other CD <br /> o <br /> authorized person to have access to the above scribed premises at any reasonable time for the purpose of inspection. m ': <br /> m : <br /> n m : <br /> cn <br /> SIGN HERE <br /> (signal a of owner or buildin c n tor) (dot ) <br /> � <br /> ZONING ADMINISTRATOR fn to v+w 40'A <br /> ((``��-��N N (J1NN(T V1 <br /> Mp NO N (1100 <br /> V O 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0000000 <br />