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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Adn6istrator - o o <br /> APPLICATION FOR LAND USE PERMITS o (� <br /> OWNER 7hAr/,T K �e Le(h TELEPHONI 71 S) � �/ — � S 7 <br /> o �C <br /> HOME ADDRESS 'a.09S�(D(� <br /> n m <br /> EMERGENCY/FIRE NUMBER a �fJ53 ROAD NAME Cfy / <br /> LEGAL DESCRIPTION(see tax receipt) tSffYh p-:- lie-r-G S Of S E�ly S&, tq SaS 7—q01V c <br /> DWELLING/BUILDING L✓J GARAGE/ACCESSORY STRUCTURE ❑ ADDITION El PRIVY 1:16 w , <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5 <br /> m <br /> STRUCTURE/ADDITION USE: /917°1 Mab//c ##M-e— HX70 <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: Oivh+ COKhTry 401h e.5 <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. r� <br /> M in V <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NmB)AND INDICATE m n <br /> NORTH(N). to o <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 I Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. . P <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. N <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. <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q <br /> NEEDED. 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <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. 4 V 1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY p� <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> A 3a ��I ; <br /> a m <br /> 6. 9 CN y 0 J E <br /> 7. O : N W =O <br /> lo': m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ti Cr <br /> c p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is ; v <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 o <br /> P 9 � PP� 9 tY 9 9 tY <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. -n <br /> m : <br /> m : <br /> SIGN HERE ' <br /> (s nat a of own wilding contractor) (date) <br /> ZONING ADMINISTRATOR d+ <br /> w rj w sn w M <br /> N Pc)N N (TP <br /> V7 NOUINOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />