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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 ci Z <br /> APPLICATION FOR LAND USE PERMITS 3 P <br /> r <br /> N w <br /> N <br /> CLC <br /> m <br /> OWNER i�� Q TELEPHONE �/9 ICY <br /> �L�ti JJ t gyp- :? <br /> HOME ADDRESS 1-)> x �G b c,��S[kif <br /> /� o � <br /> EMERGENCY/FIRE NUMBER ROAD NAMELL)tsi oCyi, <br /> SS5/ -7 z- p <br /> LEGAL DESCRIPTION(see tax receipt)Go v* C G tz,) /� / �Z6 3�/Z� ( 0 <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION ElPRIVY El m 0� <br /> TYPE OF PERMIT(S): <br /> ❑ <br /> Cr <br /> �• ' <br /> FILLING/GRADING E] CAMPI G UNIT 1:1SUBDI IS S W71, <br /> STRUCTURE/ADDITION USE: iV L y' 0 -� bl CSE Ile— <br /> (Home/Cabin; <br /> l-(Home/Cabin; Comm rcial Bus' ass; Bedroom; Deck;et . y <br /> BUILDING CONTRACTOR: fit (" <br /> � 1 <br /> m CX <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 r .cam <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p E <br /> N 4 ^r <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) Oo CD <br /> ?r -00 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 I <br /> NORTH(N). y <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m C 3 <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 7` <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 /> IL <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 <br /> � o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN r4- <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o �U <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Q� <br /> ISSUANCE. r" O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. b v <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 'tom <br /> SETBACK AREA. <br /> 5. <br /> m y o <br /> 6. "•`� vama0 <br /> a m C w o o <br /> to <br /> Z : '^ m o <br /> 7. <br /> _ur : i m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofc <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- 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 �A" m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized pen to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> m : <br /> m : <br /> SIGN HERE <br /> (signature eror it c (date) <br /> ZONING ADMINISTRATOR - <br /> N NGINNUI V1 <br /> V1 UI . rTPO o <br /> WNSHIP PERMITS MAY BE REQUIRED �0 0 0 0 0 0 o <br />