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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator -U 0 o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> V, O <br /> C <br /> ] G a <br /> OWNER <br /> 'DV � � sTews CVS TELEPHONE l9\Z' 1�� — `UIp � <br /> O <br /> HOME ADDRESS S �q2t k, �/V� <br /> r g <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) �()T Tty �Pygclfwx Ilii <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ,ADDITION ❑ PRIVY ❑ CA 0 <br /> TYPE OF PERMIT(S): --Zcr <br /> FILLING/GRADING ❑ CCAMPING UNIT F-1SUBDIVISION <br /> �-75 <br /> STRUCTURE/ADDITION USE: J 1 �S Td LtT <br /> (Home/Cabin; Commercial)Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: \ ���y`�� �.I✓ �1� 6 5i <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 �7V <br /> N C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o {` <br /> -n O 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 rn C) <br /> NORTH 0 <br /> 3. SHOW DIMENSIONSIN 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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. P <br /> 0 <br /> 4. SHOW THE LOCATION OF THE WELL(IN),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. ry V <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. 'o <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN 5 <br /> NEEDED. sai (l1CJ� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c Q <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. l <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER fel <br /> SETBACK AREA. <br /> 5. <br /> zvW D <br /> „ nI m <br /> 6. CK g; Ctn M9 3 '_ <br /> 7. o : � fD � '01 <br /> = y: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 2 i C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m E 0 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ID <br /> 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 m <br /> authorized person to ve access to the above described premises at any reasonable time for the purpose of inspection. T <br /> m <br /> SIGN HERE <br /> (signature-g" ulldingcontractor) (date) <br /> ZONING ADMINISTRATOR n c <br /> fn wfn fn <br /> t"CA NNCAR (T <br /> q V1 fT N 00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED Q�� 1 0 0 0 0 0 0 0 <br /> 0000 00 <br />