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C¢� <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N 0 <br /> N <br /> � ! C <br /> OWNER 'J71nI ts2rq / 8 / ! TELEPHONE GAS_ O <br /> c� � <br /> HOME ADDRESS ���� keh,rlare p,- 0 <br /> �60Mir�7fan joA/ SSY38 9 <br /> CD <br /> /�� <br /> EMERGENCY/FIRE NUMBER �Q 4q ROAD NAME ✓SaH /tom <br /> LEGAL DESCRIPTION(see tax receipt) 41do f <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ® PRIVY ElV7 y <br /> TYPE OF PERMIT(S): 0 0 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> N <br /> STRUCTURE/ADDITION USE: „i),Q ?ei C4 � o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) O <br /> pp <br /> m <br /> BUILDING CONTRACTOR: a✓Sa/I 814 'T14, <br /> Er <br /> T <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR � 3 � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> XI y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p _ O <br /> T a <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). C 0 <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. 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. pQ <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N 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. m c <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHENa o <br /> NEEDED. C �- <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <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. \O <br /> 3 NOGRAfDIN OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> m . m = m eL rn <br /> 6. a �ce x <br /> 7. Z !0 (D <br /> P <br /> _m: E <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c mp <br /> knowledge and belief it is true correct and complete. I acknowledge that I am responsible for the detail and accuracyof m' C <br /> g P 9 P <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 0 <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 m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection T <br /> m : <br /> CD <br /> SIGN HERE cos-� 44� „� _ - a <br /> (signature owner build g ntractor) (date) <br /> ZONING ADMINISTRATOR <br /> tr6o <br /> a"PLn Pi IOPWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 o <br />