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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoriio,,, ,dministrator -0 G) z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> o <br /> m <br /> OWNER Irf CZz` I it h C TELEPHONE 7 <br /> HOME ADDRESS (/ <br /> - Q7 !2 0 S LDn .p <br /> � 0 <br /> EMERGENCY/FIRE NUMBER ?9 a I' ROAD NAME 4 0 n e <br /> 6av Lc� 2� csh., t/03 sps/ _ <br /> LEGAL DESCRIPTION(see tax receipt) C`S s-n S U a ® , ] j 7 S h1 cslr -3 <br /> 0�0 C US 6 <br /> COD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION [71 PRIW [n <br /> TYPE OF PERMIT(S): o <br /> FILLING/GRADING ❑ CAMPINGUNIT ❑ SUBDIVISION ❑ ,_j. n X <br /> STRUCTURE/ADDITION USE: (f R P y d f c K V-(f5 j�� 1T ` �i 1 / o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) ti <br /> BUILDING CONTRACTOR: �G V\ ►Cj <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/a X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> O = <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 4 n /a T n <br /> -n z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDINGS)TO ALL LOT LINES,(B)BUILDING(S)TO m <br /> v <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS <br /> to <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATI¢rI BE DONE WHEN C ° <br /> NEEDED. UU <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. �S} o ) <br /> CONDITIONS OF PERMIT: �C//SS// C—\MIT <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PEMIT � Q <br /> ISSUANCE. 7 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHOREL�/�; <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. ZQ CO, A' <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WA CO, <br /> SETBACK AREA. <br /> 5. <br /> 37 v 0rD0 0 .0 <br /> M M. m D CL m <br /> 6. <br /> o i .0 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my cj p <br /> knowledge and belief it is true, correct and complete. 1 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 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- O <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 /> y �f m <br /> SIGN HERE <br /> (s r of own r uildin contractor (date) <br /> ZONING ADMINISTRATOR ' <br /> 16% cn cn v+49 <br /> N N (T N N N U I <br /> N (T OfT fl1 OO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />