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Burnett . ounty 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> * r <br /> N 0 <br /> N <br /> C <br /> OWNER L nd soey/Q.Lin II f oma TELEPHONE *71s _3 9a,,5.2 6 d <br /> m <br /> HOME ADDRESS 3., C S � 'n �- #.s 5S/A�p v 0 <br /> I 1 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt)s C sr--r 39 vs i( k) Qs ! / y <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ 8 <br /> Cn o <br /> TYPE OF PERMIT(S): o ' <br /> FILLING/GRADING ❑ CAMPING UNIT SUBDIVISION ❑ n <br /> �n m' <br /> STRUCTURE/ADDITION USE: o' <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) N <br /> W <br /> BUILDING CONTRACTOR: 2. <br /> CDv <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 71 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. ' <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <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 <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. P <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. CiN <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. B. 6 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHENCr S 1W <br /> NEEDED. IW^I <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 <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. Cj <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> zv0r 0� 0 � <br /> CP 7. m m a m <br /> 6. m Cam, <br /> 7. Z ` " M , o ff <br /> o 70 <br /> =ca m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my i3 c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognize �3 CD m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 CD <br /> a <br /> authorized pe o have access to the above described premises at any reasonable time for the purpose of Inspection. n <br /> m : <br /> SIGN HER J <br /> (signahno owner o building contractor) (date) <br /> ZONING ADMINISTRATOR w <br /> N N 0 N N ut N <br /> V1 <br /> PPPPPP <br /> TOWNSHIP P RMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br /> 0000000 <br />