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(no?Qt�1�P <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o° o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N O U <br /> N <br /> CD <br /> OWNER O0.V l DoVICJ U e- TELEPHONE 65-/ (Y? J 36 0 <br /> W <br /> 7 i ,,y� m Cv- <br /> HOMEADDRESS 6l q SK9ll vqy, AJe W Cn5, Ur /le / / Al Ss��3 <br /> r m <br /> r p <br /> EMERGENCY/FIRE NUMBER a�4 q6 ROAD NAME Ye l)o v,) Rl d el' <br /> pd <br /> r <br /> � <br /> LEGAL DESCRIPTION (see tax receipt) � '/ �J <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION I/J PRIVY ❑ N ° <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVIS ON 1:1 < <br /> STRUCTURE/ADDITION USE: ; 0 <br /> (Home/Cabiner <br /> A ; Commci Business; B droom; Deck; et .) m <br /> A � <br /> BUILDING CONTRACTOR: lone <br /> I ZD <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 \ <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> M c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a - <br /> -n O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m C <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. ° <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO O <br /> BUILDINGS, ROADS,LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <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 ^» <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 0 1 ' <br /> CONDITIONS OF PERMIT: m <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT JU <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. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> n � DD � m0 3 n m <br /> 6. o m cN m 5 3 <br /> 7. o XI <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 0 2 p <br /> knowledge and belief it is true, correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of o A <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize C <br /> PP ( 9 Y ) 9 m � : p <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above des ribed premises at any reasonable time for the purpose of inspection. m <br /> Win/ 'yin / m <br /> SIGN HERE Cs ( v „ ����—c) ;^ <br /> (sigma n�aV�e of owner or building contractor) (date) (y j}$ <br /> ZONING ADMINISTRATOR �11��OI� ✓1 Til <br /> TOWNSHIP PERMITS MAY BE REQUIRED lJ <br />