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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 'U c� Z <br /> APPLICATION FOR LAND USE PERMITS 3 4 1 <br /> OWNER4/tt31it1 71 _6 S6"3118 � � W <br /> Jj"[-S - S.#A4Y 'I PA✓Er_ <br /> A TELEPHONE a1ME 6S/—�S���/,( C \ w <br /> HOME ADDRESS /'1�I PD/VD WILE FAST p'tz'NAdTA Ms, /'v s.5 1 j b ;? O <br /> EMERGENCY/FIRE NUMBER66 n O ROAD NAME A'DU L&E P <br /> '3—;t s 5 3? <br /> 3 Sta3 Tyu Idw *,Rs ..:)3a <br /> LEGAL DESCRIPTION(see tax receipt) _LID—i6— d 3—D 0 13 p p I_trr 'L CSM it 1 P 192- Q�:) C <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ y <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING 0 CAMPING UNIT ❑ SUBDIVISION ❑ a 1 <br /> STRUCTURE/ADDITION USE: S NLCD P VVX W V S E 1 y' -V W o. <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) rn <br /> BUILDING CONTRACTOR: <br /> A PLAT PLAN MUST BE PROVIDED ON AT LEAST AN 8'h X 11 SHEET OF PAPER. ANY INCOMPLETE OR �^ <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O 3. <br /> N <br /> DIRECTIONS FORPLOT PLAN DRAWING• (AERIAL OR TOP VIEW) 0 C <br /> cL <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. In 0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 9 <br /> NORTH(N). C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF ` v <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. c <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 3 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY o <br /> BE DONE WHEN a S <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o ' <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. 1 <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 /> SETBACK AREA. ` <br /> 6. <br /> ,_j_ � n ;a:? o gokov <br /> 6. /- <br /> cS7►tttCLpe {p �p{ /5DM d j fiI//�') o �C 3 a m a <br /> 7. Z : v��i R i ' q <br /> o <br /> _CO m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 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 0 c <br /> all information contained in this application(including any accompanying schedule)and 1 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- p <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 /> (D <br /> authorized person to havp access to the abche descr' ed premises at any reasonable time for the purpose of inspection. <br /> m <br /> SIGN HERE ql)3) lq d' . <br /> gna re of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> ��E�"N�, <br /> N NCIPI 01 <br /> 0 NIn 0c:) <br /> Vt CnO (ll V7OO <br /> TOWNSHIP PERMITS MAY BE REQUIRED / 0 0 0 0 0 0 0 <br />