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WZYKP <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v c� Z <br /> APPLICATION FOR LAND USE PERMITS 3 �-0 <br /> N <br /> OWNER TELEPHONE / 5p � JVj 0 <br /> nn IF <br /> m <br /> HOME ADDRESS D , U 'C, v 0 <br /> o �^ <br /> EMERGENCY/FIRE NUMBER <br /> -30� 'l ROAD NAME s t f Q <br /> I <br /> LEGAL DESCRIPTION see tax receipt) ',. y' �/ Cn <br /> �r m <br /> DWELLING/BUILDING .I GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ c c <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING CAMPING UNIT <br /> ❑ SUBDIVISION ❑ c <br /> pp�/ 7 �Q N <br /> STRUCTURE/ADDITION USE: OM2 O� dX 3(o � �F-y'`-' o <br /> (Home/Cabin; Commercial Business;'Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: W-t e-- 6AA �u l )LJ%-%9— <br /> .� <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 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 /> 'fl <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. t7 m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m I <br /> NORTH(N). <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO tNrl B <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. b <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 I <br /> � o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN a 0, <br /> NEEDED. Q) So <br /> 2 <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 <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. ^j <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. y1^� <br /> 5. <br /> A V C>y <br /> CD p CD rn L <br /> " • m � 2ia m <br /> 6. 0M m cNo 'CD 3 <br /> 7. Z : m fD < : , =jo : <br /> cn : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m E <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize M <br /> M <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- O <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. -n <br /> m : <br /> m <br /> SIGN HERE �f 0o <br /> (signatureo o eror n (date) <br /> ZONING ADMINISTRATOR ��C:F) ' to <br /> v+cnwcnviw-+ <br /> N N(T N N nt UI <br /> fT fTOfT (ll OO <br /> T NSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />