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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator CD- o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> U) ° <br /> OWNER ��� C e �, L// TELEPHONE <br /> ,�h� v n; d �T Fr d . <br /> to <br /> HOME ADDRESS 73y7J/��lJ �[i I�t l� IJLcrk/ <br /> o <br /> EMERGENCY/FIRE NUMBER 72 ROAD NAME .. <br /> Y7 s !/�+/ O >LAe- .s ��! Jacc��f'ai7 1 <br /> LEGAL DESCRIPTION(see tax receipt) fown Sti�P cfD /I/p/7I R , arye /� CcJ�67� �crne �o4rh� cn <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION PRIVY ❑ co C <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADI,NG/❑ CAMPING UNIT ❑ �BDI [SION El / S. <br /> STRUCTURE/ADDITION USE: OA4 6r1 �O (A 0 Y' 0fM, ) Y �T A' I�.q g c� I �o r �le �� <br /> (Home/Cabin; Commercial Business; Bedro ;Deck,et . i 'e- rn <br /> m <br /> o_ <br /> BUILDING CONTRACTOR:r31j—C Cp h/d c, <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR ,e 3 <br /> IMUST <br /> RETURNED. 0 .. <br /> rx f/ O <br /> NS FOR PLOT PLAN DRAWING• (AERIAL OR TOP VIEW) n n <br /> -n o z <br /> REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m " u <br /> THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m o <br /> TH(N). y <br /> W DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m t<v <br /> ERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <br /> E,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> W THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO Q <br /> DINGS,ROADS,LAKE,LOT LINES. <br /> CATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. fV <br /> PARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS f . � <br /> T BE SIGNED AND DATED BY THE OWNER. �o 1 <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN cl-� a ° <br /> NEEDED. UJ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. P O Q <br /> CONDITIONS OF PERMIT: <br /> 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT � 1 <br /> ISSUANCE. j <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 �7 <br /> SETBACK AREA. <br /> 5. m = mm M m <br /> m ,`2 a3 K %a= — ;a <br /> 6. N 0-9 c 719 i <br /> ;a <br /> 7. =_int E <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my I� C <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of i <br /> L <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize O: ;M <br /> L7. <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <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 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. - <br /> CD : <br /> '69 <br /> SIGN HERE <br /> : <br /> (signature of wner or building con r) ^, (date) <br /> ZONING ADMINISTRATOR <br /> UNI NONNOO <br /> O <br /> 0000 00 <br /> WNSHIP PERMITS MAY BE REQUIRED <br />