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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning AdminAi trator v 7 z <br /> APPLICATION FOR LAND USE PERMITS �j.�/� 3. <br /> I l�o n <br /> OWNER �Ill� � / �� ��CL TELEPHONE /pS YS"S-7qq o <br /> m <br /> HOME ADDRESS 9CIs3 Ulcnhttm LCL,L� /fir/" v 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME 13r <br /> o <br /> prel �'n �cs�T �Ur S', T38/J--r{<7W � <br /> LEGAL DESCRIPTION(see tax receipt) m <br /> D�tnicLS Tecy.�� :a - ,(3cr rnt�t I C <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION PRIVY ❑ cn ° <br /> TYPE OF PERMIT(S): ((( <br /> Q <br /> FILLING/GRADING ❑ ElCCAMPING UNIT ❑ SUBDIVISION n <br /> STRUCTURE/ADDITION USE: 01 Age rpoms 0 <br /> (Home/Cabin; Commercial Business; edroom; Deck; etc.) rn <br /> m <br /> BUILDING CONTRACTOR: OFCD <br /> 1 <br /> C <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. 0 <br /> :0 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> n <br /> Tz <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <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 <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 <br /> BUILDINGS, ROADS,LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. o N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, ZMA <br /> TC.,THE PLANS ° 1 <br /> 0 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 <br /> LLD o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIF ATIO <br /> NEEDED. r p T <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. �F v � Z \ <br /> CONDITIONS OF PERMIT: BURN ° <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ZONING <br /> COUNTY <br /> ISSUANCE. I <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 /> SETBACKAREA.5. <br /> aN: m <br /> 6. 0 CD m <br /> d w ov63 ' c/2- ��j 4e - <br /> Oct _ y <br /> 7. <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me a m C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and a a y ° XI <br /> — <br /> all information contained in this application(including any accompanying schedule)and I further declare that m (D <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information lam m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. fD <br /> ( : <br /> m : <br /> SIGN HERE ���r` .�ta� �.1 9- d y- <br /> (sign e f owner or ui ng ontractor) (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />