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&LUQ <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3< ° <br /> U7 O <br /> N <br /> CD <br /> C <br /> / <br /> OWNERy.1-,�� TELEPHONE (pS� ����/_g y <br /> r0 v <br /> a <br /> HOME ADDRESS I �� Cedar ne�!S[ `�jr` { JG rtj~s IU U3� v 0 <br /> r m <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME Z <br /> � an <br /> LEGAL DESCRIPTION(see tax receipt) O Kj l�dt Z e A <br /> 1 J- ` m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ <br /> 0 <br /> TYPE OF PERMIT(S): <br /> or <br /> FILLING/G DING ❑ CAMPING UNIT SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: �)�� MUT�� �j � y. <br /> 0 <br /> (Home/Cabin; Commercial Business; Bedr om; Deck; etc...1 <br /> BUILDING CONTRACTOR: ��" (./� <br /> av <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/z X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 c <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -- <br /> x N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p <br /> -n m <br /> n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE FF <br /> NORTH(N). N �3 <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 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. <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 0 �. <br /> MUST BE SIGNED AND DATED BY THE OWNER. S o <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN 0 0 <br /> NEEDED. Ct <br /> 0 ) <br /> \ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Zo <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I <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. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5.6. y <br /> m -0 r 0 � 0 G <br /> 7. Z : 1^ COD 0� � <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my - m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m CL i? C <br /> all information contained in this application(including any accompanying schedule)and 1 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- 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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. CD <br /> m : <br /> SIGN HERE O <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR r <br /> wtnt»f»cncn� <br /> N N (J1NNfT U1 <br /> ut ut O Ut O O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />