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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator "V 0Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> 64/) 7/5-6 35—I;z <br /> OWNER TELEPHONE 715-635 <br /> m <br /> HOME ADDRESS f��� �7ZQ �Pl� 0 <br /> � o <br /> EMERGENCY/FIRE NUMBER ROAD NAME G e � <br /> LEGAL DESCRIPTION(see tax receipt) 42 y <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE XADDITION ❑ PRIVY ❑ \ <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING 1:1CAMPING UNIT ❑ SUBDIVISION ElCL <br /> STRUCTURE/ADDITION USE: LyeG/G o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) N <br /> BUILDING CONTRACTOR: <br /> /7 <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> Y: <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> c Q. <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) 0 CL <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). a or <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO ryrl \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. ( o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO v O <br /> BUILDINGS,ROADS,LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N (1 . <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS X1.1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. �i n 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN " a 0 <br /> NEEDED. 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z n <br /> CONDITIONS OF PERMIT: <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 /> SETBACK AREA. �^ J <br /> 5. �� �{'® �7y� �S WICQtt/7/�� c ��'�!o m � m m�'++ rno <br /> — Cn x <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 ofCL <br /> C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize Mm m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- p <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 ave access to the above described p mises at any reasonable time for the purpose of inspection. <br /> m : <br /> SIGN HERE <br /> (signatu of owner or building nttrr�actor) (date) <br /> ZONING ADMINISTRATOR !/ / . . . <br /> 40�040baCAM <br /> N N <br /> 01NN(n V7 <br /> Vt NONUtOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />