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91 <br /> 4 C ruz PC- cvt UYvtj'40 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> OWNER <br /> .� TELEPHONE � <br /> v <br /> v <br /> HOME ADDRESS 7 ^�CA) ) V fl-L� 0 <br /> CD <br /> EMERGENCY/FIRE NUMBER ROAD NAME �4j <br /> LEGAL DESCRIPTION(see tax receipt) N <br /> 1CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ N o' <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> r _ / f < <br /> STRUCTURE/ADDITION USE: �ZT (-l-PD� c_ <br /> o' <br /> Cn <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: 150ELr r <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 m <br /> -n <br /> n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> m <br /> NORTH(N). C 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m a <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 <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N C:> <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS I� <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o � W <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: p <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT - <br /> ISSUANCE. �1 <br /> ? REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. G <br /> 1. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY U <br /> PERMITTED. <br /> NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> CDvQ3v0oaov <br /> 0 < n 2 0, <br /> cn <br /> o <br /> O TI <br /> - � m <br /> declare that this application (including any accompanying schedule) has been examined by me and to the best of my Q <br /> nowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of Q <br /> II information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> iat this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- G) v <br /> ue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am 47 <br /> roviding in this application. I agree to permit county officials charged with administering county ordinances or other <br /> CD <br /> utnorized person to have access to the above described premises at any reasonable time for the purpose of inspection. -n <br /> CD <br /> m <br /> IGN HERE <br /> Z�;W(si nat�ofn r building contractor) (date) <br /> DNING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />