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R) <br /> �c <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of& ng Admin�r -0 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> el 0 <br /> N (� , <br /> c �lJ <br /> �n t�� 7�O(, a c� <br /> OWNER TELEPHONE J <br /> HOME ADDRESS „FSC led— 1711 — �Q�1�iGf/Z (� �� 5 y ��o <br /> EMERGENCY/FIRE NUMBER W ROAD NAME �6.�-�.� �d 77 1" ~ <br /> LEGAL DESCRIPTION(see tax receipt) Y� � —�I — l (� v0� <br /> v1 <br /> a <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ <br /> TYPE OF PERMIT(S): Cr <br /> c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISIO S. <br /> S. <br /> STRUCTURE/ADDITION USE: / / I V A':) <br /> (Home/Cabin; ommercial Business; Bedroom;Deck;etc.) cn <br /> BUILDING CONTRACTOR: 1 ,, i5 IJJ <br /> v <br /> rn <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR In 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 c <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 C n <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 3 <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. c <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. Q <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. o I <br /> o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN cr <br /> NEEDED. w <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ' <br /> ISSUANCE. i <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. <br /> 5. <br /> 3 a <br /> m <br /> a cCL <br /> 00 . c ' 3 <br /> 7. o : N (DQ <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of nit <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognizeCD <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 m' <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. -n <br /> m : <br /> m : <br /> w : <br /> SIGN HERE <br /> (signature of o ner or building contractor) (date) <br /> ZONING ADMINISTRATOR �+ <br /> � NOulN00 <br /> TO NSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br /> 0000000 <br />