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nt <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -U C) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N O <br /> N <br /> OWNER R ICV 1 j C�[ TELEPHONE D g 63� 3 n S O C� <br /> 1� d <br /> m <br /> HOME ADDRESS111j CD <br /> EMERGENCY/FIRE NUMBER 3 6 4� Ln o,J I It Q61 ROAD NAME ( 6cv Leh 1` <br /> LEGAL DESCRIPTION(see tax receipt) G ST )W yt7 f2 NwP c iS yjfSfi m <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ N <br /> TYPE OF PERMIT(S): (� <br /> FILLING/GRADING 1-1CAMPINGUNIT ❑ SUB VISION ❑ vl n <br /> 4,;u5,0 <br /> STRUCTURE/ADDITION USE: cvh� �TG�L� C— CCL kII� <br /> (Home/Cabin; Commekial Business, edroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: lir (� " <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> ;a N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIE" O o. <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 <br /> NORTH(N). o <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. I <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. �j O <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 1 N C <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS yJ <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> "'V O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT O <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 ARy�7p �ycf <br /> 5. !"�I '�/"t..- ��/— /U � r.--0 0 0 0 <br /> c� 7. N 9 <br /> N L m <br /> 6. m,� a C=L CD M <br /> CD c:0,7. o 3 <br /> o <br /> y : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of O a C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize Q 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 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. m <br /> ko : <br /> m <br /> w t' 4W <br /> SIGN HERE <br /> (signatur f noror uild g co (date) <br /> c p <br /> ZONING ADMINISTRATOR o�a—/t� • • • . . Fn <br /> X40""404 <br /> N N4, N N MUt <br /> P (n O [ M O O <br /> WNSHIP PERMITS MAY BE REQUIRED c c c <br /> 0000000 <br />