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nLUyW <br /> Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> �7 / n <br /> OWNER �� SbYI� TELEPHONE ( ��pp.� –7— (1p D <br /> 7 <br /> ln lU� OO �J v <br /> HOME ADDRESS � �/`�'l�� . ��� <br /> ` ,1 m <br /> EMERGENCY/FIRE NUMBER 3��q 3 ROAD NAME S j 3.-S I LEGAL DESCRIPTION(see tax receipt) N G/S( sEs a8 — 4 ' [� ` I M <br /> DWELLING/ BUILDING ElGARAGE/ACCESSORY STRUCTURE El ADDITION ❑ PRIW ❑ c <br /> TYPE OF PERMIT(S): rr <br /> FILLING/GRADING El CAMPING UNIT ❑ SUBDI ISIONN 5. <br /> STRUCTURE/ADDITION USE: �m U Ila � <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) �O/ C rn <br /> BUILDING CONTRACTOR: <br /> ��h er IT �\ <br /> v <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. p <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) <br /> O a <br /> o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m :b <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). rR \ ° <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> P <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. N \ <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS 7 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o t <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED. W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o �d <br /> CONDITIONS OF PERMIT: ^ ) <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 4J <br /> ISSUANCE. �1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ,f II A <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 'w1, <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. Dp <br /> CL <br /> 6. v' mCX RL Cm o 9 3G <br /> 7. o� <br /> Cn <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my L3 ID p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o Er C O <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize `t !a 6; m: <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- \ m 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 ? )03 <br /> providing in this application. 1 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. m ': <br /> CD Ci <br /> m P <br /> SIGN HERE vv <br /> (signature of owner or building contractor) (date) C <br /> ZONING ADMINISTRATOR <br /> w to cn W is to <br /> �oriM <br /> 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 g <br /> 0000000 <br />