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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o �s <br /> APPLICATION FOR LAND USE PERMITS _3 <br /> N 0 <br /> 3 1 N <br /> OWNER <br /> TA�jC y L � TELEPHONE .}(,s 96 6-3;7 9 <br /> O <br /> HOME ADDRESS Ctb� bRkr� stFr 01 L-74 p mori1/ <br /> Ei3 <br /> r rn <br /> EMERGENCY/FIRE NUMBER 3y '3:�- ROADNAME CI4"61,/ETH <br /> I <br /> LEGAL DESCRIPTION(see tax receipt) NW �� SW y4 $3 b y0 A/ R )q W ti <br /> cam <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY <br /> TYPE OF PERMIT(S): i a <br /> Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ L <br /> STRUCTURE/ADDITION USE: "R ItEkH rrp-& ' <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) m O Cs <br /> m C` <br /> BUILDING CONTRACTOR: <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. m - <br /> O <br /> M <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> n <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m o z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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 C <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 a o, <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: ° <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT d <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. �{I <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> m m = m m <br /> 6. � � 3a mat ,-p <br /> C e— <br /> 'o m am !" > > 3 <br /> 7. z COD to i <br /> P <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Q c m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of O m c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 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 m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> M <br /> SIGN HERE <br /> (signature o ner ilding cont or) (date) <br /> t <br /> ZONING ADMINISTRATOR E <br /> Zn NG (n <br /> NNN <br /> / O (n fT00 <br /> TO NSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 <br />