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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 _ <br /> 3 <br /> N <br /> CD <br /> `/ <br /> OWNER �(�Q I \ y G LL TELEPHONE <br /> C;Z5a0 01 6n'ot ) O� <br /> HOME ADDRESS ^Z S Ci SA Il D ��� f� I�, aac (Y1/�l � � (D <br /> r m <br /> o i <br /> EMERGENCY/FIRE NUMBER 7 O l ROAD NAME -5,q-,V 1-0 <br /> �. <br /> LEGAL DESCRIPTION (see tax receipt) ( �5 m �/ �� D "I-, ` CD <br /> m <br /> O A <br /> DWELLING/BUILDING ElGARAGE/ACCESSORY STRUCTURE Jl_X ADDITION ❑ PRIVY ❑ o <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: — �c S O✓ A/ rk )c iE L=V L�— V ' <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) cn <br /> BUILDING CONTRACTOR: —J I �- d =Y2- L /7 aT ° <br /> If ' <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLE E OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n <br /> n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2 .SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m o <br /> NORTH(N). 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m z <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <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. S2� <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. O f <br /> o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 9 <br /> CONDITIONS OF PERMIT: i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <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 /> 5. A n r D O D 0 <br /> CD d n CD O h m <br /> 6. -o : mcN = <br /> Z <br /> ic <br /> . <br /> N m 0 o <br /> �n <br /> �. m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) 2 c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of a 0 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize <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 otherCD <br /> authorizedapeonto have access to the above described premises at any reasonable time for the purpose of inspection. mmmSIGN HER (1(signatureeof ownfpr building contractor) (date) DO <br /> ZONING ARATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />