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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator o <br /> APPLICATION FOR LAND USE PERMITS 3. w <br /> r <br /> i o <br /> OWNER / 082 TELEPHONE <br /> 970 R Ter /V <br /> HOME ADDRESS 046 1/63 9 <br /> m <br /> EMERGENCY/FIRE NUMBER p� I"1 ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) av . 66 �s alb -y,—(s- c <br /> W <br /> 0 <br /> DWELLING/BUILDING c <br /> GARAGE/ACCESSORY STRUCTURE ADDITION PRIVY ❑ ( � <br /> TYPE OF PERMIT(S): 4 v <br /> FILLING/GRADING 1:1CAMPING Up IT 1:1SUBDIVISION ❑ S. <br /> Cf},e/A/ - Net t)-Rwr- �' `" Q, <br /> STRUCTURE/ADDITION USE: 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) 0 <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m X <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <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. I <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 0. ) <br /> MUST BE SIGNED AND DATED BY THE OWNER. o so ( 1y <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q <br /> NEEDED. a P <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z ) <br /> CONDITIONS OF PERMIT: P <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT U 1 <br /> ISSUANCE. t 0 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY (j <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. om 6< <br /> mcy "0 ' 3 <br /> Z R M <br /> 7. 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 rj C) <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of r(� o <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize -E m m m <br /> that this information I 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 f <br /> authorized per,4enffo- vqjjaccess to the above described premises at any reasonable time for the purpose of inspection. T <br /> MCO <br /> SIGN HER <br /> (signatt;reeoof owner b ing contractor) (date) <br /> ZONING ADMINI RATOR J 1 <br /> N 40 <br /> to N V fT <br /> fT fTOG1 CTO <br /> 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0' <br /> 00000 <br />