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�(✓� , <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m 0 <br /> o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r \I+ <br /> N <br /> C <br /> OWNER TELEPHONE 178-, ,3 077� <br /> m <br /> CD� <br /> HOME ADDREa <br /> SS 3,? D �S � ty 1 C7O Fr � ux/ � <br /> r � <br /> 0 <br /> EMERGENCY/FIRE NUMBER 4/ Vol ROAD NAME Af d41,9 E 'O p I I/E <br /> I <br /> LEGAL DESCRIPTION(see tax receipt)L O , 4 m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION PRIVY ❑ N a' <br /> TYPE OF PERMIT(S): <br /> FILLING/GRAD ❑ CAMPING UN T 1:1 SUBDIVISION ❑ �' <br /> N <br /> STRUCTURE/ADDITION USE: (c (,( � o' <br /> (Home/Cabin; ConUercial Business; Bedroom; Deck; etc.) Cn <br /> BUILDING CONTRACTOR: ,�/) y (,-'a/Uf 7r&e,7/O /✓ 2. <br /> C <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN SYz X 11 SHEET OF PAPER. ANY INCOMPLETE OR � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n - <br /> y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p m <br /> n a <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n ;u <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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. 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. O <br /> 6. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. IN <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 <br /> � o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a. O <br /> NEEDED. ( (� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <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. I <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. ,wl <br /> 5. n, ;cue <br /> XT W 00imafm <br /> a CD <br /> , <br /> W : 0 � � <br /> 7. <br /> ( /�j �n /J✓ in O O <br /> - � : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m c m <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- CD�j <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 <br /> authorized pens o have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> m <br /> CD <br /> SIGN HERE <br /> (signature of ow er or building cont (date) <br /> ZONING ADMINISTRATORS/ .. <br /> T NSHIP PERMITS MAY BE REQUIRED <br /> l7 �, <br />