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cf)-dp <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator y ° <br /> OWNER ��• -U 0 Z <br /> APPLICATION FOR LAND USE PERMITS �� _ ID <br /> l- ° <br /> � <br /> y <br /> C <br /> e OL TELEPHONE �,�6� yF-7CJI o � pd <br /> HOME ADDRESS ��_�� d /� l EO <br /> EMERGENCY/FIRE NUMBER ROAD NAME ee<�epv/I <br /> LEGAL DESCRIPTION(see tax receipt) L / C�fn VS �3a() S X�f �/W—�y� <br /> C/ cD <br /> CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE O ADDITION ElPRIVY ❑ Q a <br /> TYPE OF PERMIT(S): cn o <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: 12 <br /> _ (/ <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/z X 11SHEET OF PAPER. ANY INCOMPLETE ORCD <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n 3 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) <br /> O an <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n 0 �1 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m eo3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF t 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 O <br /> BUILDINGS, ROADS, LAKE, LOT LINES. / <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Ncis <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. -i <br /> � o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z (� <br /> CONDITIONS OF PERMIT: o <br /> 1 Q <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. _ ^ <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 /> SACK AREA. <br /> 5 CD W DODOM <br /> 7. Z : � CD0 !" �� 3 <br /> o '71 : A <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �j p <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 l- CD rn <br /> that this information I am providing will be relied upon by the County of r eft Wisconsin in determining whether to is- O <br /> sue a permit. I further accept all liability which may be a result of the C y anon I am <br /> providing in this application. I agree to permit county officials charge I r s or other <br /> authorized person to have access to t bove cribed premises at an i ur spection. `D <br /> c CD <br /> CD <br /> SIGN HEREJUN ' ©/ <br /> ure o er or building co r) (da <br /> ZONING ADMINISTRATOR <br /> ZONING <br /> TOW SHIP PERMITS MAY BE REQUIRED <br />