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m 1 <br /> Burnett Co my 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -V 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N ° <br /> N ' <br /> OWNER 606 TELEPHONE <br /> co <br /> w <br /> O <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER NAD NAME "I� <br /> LEGAL DESCRIPTION (see tax receipt) / /_OrJ C1IIT/ <br /> [D 4J v Y � <br /> DWELLING/BUILDING D GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ m ° <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING El CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: [9 /7i e S S% ° ` <br /> (H a/Cabin; Commercial usiness; Bedroom; Deck;etc.) Cn <br /> m V' <br /> BUILDING CONTRACTOR: Er <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> -.5 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> T o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y ° <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <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. P <br /> av <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. `2 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ii <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. o a <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHENv 0 <br /> 4 W <br /> NEEDED. oi-I THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: k <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 Cr <br /> PERMITTED. V� <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. sem V6[ 41, <br /> �iare- 7lS <br /> X 'v 0Ir" o � <br /> 6. m � 3 a <br /> c N m ° <br /> 7. Z O • <br /> . <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my tj c p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m C <br /> n : : <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize - M m m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- D <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 tq the abov escribed premises at any reasonable time for the purpose of inspection. m <br /> CD <br /> m : <br /> 69 <br /> SIGN HERE <br /> (si at e o ow r or building con c r) (date) <br /> ZONING ADMINISTRATOR tL�� • . • . . to <br /> to towf»cn49 <br /> N NNNNfTN <br /> N (/tONfT00 <br /> TOW HIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br /> 0 0 0 0 0 0 0 <br />