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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> 0 <br /> y O <br /> OWNER f lGn� TELEPHONE 3� / �J ! [s 1j <br /> Z-` <br /> HOME ADDRESS ✓/ W ( S�OOrins, FMC S <br /> 0 U <br /> m <br /> EMERGENCY/FIRE NUMBER �lJy ROAD NAME W�1tSDerin� Tl �F.� <br /> '/ 1 <br /> LEGAL DESCRIPTION(see tax receipt) �' ( )Y� Sl^}y 5��1 C// 3�N 2��� m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION PRIVY ❑ ° <br /> TYPE OF PERMIT(S): \ Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: G/t//A14L(H � 'LX�✓� / -�P�f �UM ���JM'Sw <br /> � <br /> ome/Cabin; Commercial Business; Bedroom; Deck; etc.) ur <br /> BUILDING CONTRACTOR: cS 1e'`"e <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/a X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 f , <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p W <br /> XI N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 0 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y '� c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 6Q v <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 0 <br /> BUILDINGS, ROADS, LAKE, LOT LINES. W <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 \ <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q ° <br /> NEEDED. -°. �A \ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o C <br /> CONDITIONS OF PERMIT: (� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMITf I. Q <br /> ISSUANCE. W C <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. <br /> 5. <br /> 6. I'O � 3nm � � <br /> mcN !" 0 � 3 <br /> _ <br /> in :cr : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 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 <br /> 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 m <br /> authorized,person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> m : <br /> CD : <br /> SIGN HER <br /> (sign ure of owner or ildin contractor) T (date) <br /> ZONING ADMINISTRATOR <br /> w cn cn cn• <br /> N NVtN O <br /> V1 V1 O Vt O <br /> TOWNSHIP PE ITS MAY BE REQUIRED <br /> 0 <br /> 0 0 0 0 <br />