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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. < <br /> OWNER ArThloy- �gJru�� LAd TELEPHONE (7/F) 63S 7�yy <br /> e <br /> / I m 001 <br /> HOME ADDRESS 1661 At*x (fid ipavt all 5WO1 c� <br /> 0 <br /> 0 <br /> EMERGENCY/FIRE NUMBER &6� ROAD NAME by f <br /> P <br /> LEGAL DESCRIPTION (see tax receipt) r��/ryQ /R I yW Pm4 6011 4ot y 13. 0 cc� CD <br /> DWELLING/BUILDING ❑ GARAGE//ACCESSORY STRUCTURE 1251 ADDITION ❑ PRIVY ❑ Un 0 <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> m <br /> STRUCTURE/ADDITION USE: rGI"AQP o <br /> 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: /t'�lY io <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 9 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. mm <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE CD <br /> NORTH(N). Ch 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <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. 0 <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. G <br /> 6. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. IN <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. 0 0 <br /> l WE oNOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFI( ENEEDED. <br /> I I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. J 1�F WY� o C' <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PER11 WRNETT COUNTY <br /> ISSUANCE. ZONING <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY I <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. C <br /> 5. � � \/ `f'l� + —e�_ �iLe / �ZZ!/lG( M -0nvDODo -0 <br /> CD W <br /> /[/ `/` /ej / Z <br /> 7. / Q �/ om <br /> - w ; <br /> I declare that this appli anon (including an accomp ying schedule) has been examined by me and to the best of my Lj A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize \, <br /> 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 Ior' <br /> authorized person to have access tot b ve described premises at any reasonable time for the purpose of inspection. T <br /> m : <br /> CD : <br /> SIGN HERE O � <br /> (signature n ;r building co cto) ` (date) <br /> ZONING ADMINISTRATOR l <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />