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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator vL7 Z <br /> 'APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> y O <br /> N <br /> OWNER Co�{ ' ^„_ � TELEPHONE LVf q 4q 13 O <br /> HOME ADDRESS t34D5 28� +'A -IJ'1 { � <br /> /��E 'Zatr+�wt.r�2w�.,o�..1 rvti..J SS398 � <br /> c> <br /> EMERGENCY/FIRE NUMBERA <br /> �' _ ROAD NAME � � <br /> LEGAL DESCRIPTION (see tax receipt) V7 <br /> �RQ13 to L-OTCD <br /> DWELLING/BUILDING C& GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIW y0 <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> H <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) Cn <br /> m <br /> BUILDING CONTRACTOR: lir ^ <br /> '� �U+, <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. In 3. <br /> M <br /> DIRECTIONS FOR PLOT PLAN DRAWIN • (AERIAL OR TOP VIEW) O ` Q <br /> -n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. TZ <br /> v <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m A <br /> NORTH(N). C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m +v ~ <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. @@--,' o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO W <br /> BUILDINGS,ROADS,LAKE,LOT LINES. 1 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. n1C'1 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. c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONEWHEN <br /> NEEDED. ° <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: p <br /> ` <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. f <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER p <br /> SETBACKr4REA. <br /> zM. '= 0 v � <br /> 6. m � 3 am `:Q M <br /> N C N .'" o <br /> 7. Z @S ° rc � <br /> ° S2 i A <br /> I declare that this application (including an accom an In schedule has been examined by me and to the best of my 2 p <br /> PP ( 9 Y P Y 9 ) <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of io E' C <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,��yj¢¢p�nty of Burnett Wisconsin in determining whether to is- v <br /> sue a permit. I further accept all liability which may btltJf tjun of Burnett relying on this information I am <br /> providing pP 9 P y ` p1 '• <br /> p gin this a licatio I a ree to permit count officials c t inistering county ordinances or other <br /> authorized person to hav c s to the above described pre 'ses at an a ale time for the purpose of inspection. <br /> m <br /> CD <br /> SIGN HERE <br /> (signatur f ow er or building c ( te) (+.i <br /> ZONING ADMINISTRAT vy <br /> �N N V 1 N N N 01 <br /> Vr VI O fT N O O <br /> TO SHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 <br />