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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 3. <br /> r <br /> N � w <br /> N <br /> C <br /> OWNER i 5 TELEPHONE <br /> HOME ADDRES� 15� kier <br /> EMERGENCY/FIRE NUMBER g 4(b) Cb <br /> NAME <br /> K) ) R <br /> LEGAL DESCRIPTION(see tax receipt) 100 I O 4(b) v &OU <br /> as -38 - IS <br /> DWELLING/BUILDING ❑ <giiG CCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ 0 <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING ❑ CAMPING UNIT E] SUBDIVISION ❑ c <br /> iia �aQ,c <br /> STRUCTURE/ADDITION USE: 3a— <br /> (H a/Cabin; Comr&cial Busines , Bedroom; Deck;etc.) C <br /> BUILDING CONTRACTOR: I <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> O <br /> M y ^ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) OT a VCJ <br /> -111 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m a <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 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. D <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. M0 1 <br /> o 9 (1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. W <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. / /_ ��, /J (j��7 <br /> 5. � Lam- Q... IU-3I 1 C./ centu-iC- 41.12_ — U <br /> �� n V r <br /> 6. m C <br /> 7. O N N <br /> Via,: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my tj c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of (� <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- ` l7 <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 <br /> providing in this applic I agreeto ermit county officials charged with administering county ordinances or other pC m <br /> authorized person ave gocess tot ove described premises at any reasonable time for the purpose of inspection. T <br /> %V . <br /> CD <br /> SIGN HERE � <br /> (signatur f owner or bull r) (date) <br /> ZONING ADMINISTRATOR <br /> Fn dr Fn to to to <br /> N NCnNN [nN <br /> fT N O P !-" O O <br /> 0 <br /> OWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 <br />