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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -U L7Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> m <br /> l m <br /> CL <br /> OWNER I I�'H I`, Q NKt? TELEPHONE �l �— y 51(I V o <br /> \\ /� /� I <br /> HOME ADDRESS ' S ri I l ti /� Q /< U Fle d L-2/L J`f�3 9 <br /> EMERGENCY/FIRE NUMBERI S l ROAD NAME /q <br /> T <br /> LEGAL DESCRIPTION (see tax receipt) <br /> SeL �S 1 17 A Nw <br /> DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ rn 0 <br /> TYPE OF PERMIT(S): <br /> cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ �' <br /> N <br /> STRUCTURE/ADDITION USE: <br /> �N0✓y1 e o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: S2 I fes,' <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. <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> �t o. <br /> 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 fD <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Od 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. O <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. c l <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHENq S <br /> NEEDED. 0 ` <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o O V'i <br /> CONDITIONS OF PERMIT: 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMITI <br /> ISSUANCE. 6 1 ' <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY T C <br /> PERMITTED. 043 <br /> 4. NO STRUCTURES, INCLUDING RETAINING <br /> W�ALLLS, ETC.,,ALLOWED <br /> WITNTHE <br /> REQUIRED WATER � 6� <br /> 5. <br /> SETBACK <br /> V ' � Da `�XIS75� l --h) h� �� ,� O <br /> ' n <br /> 7. z : @ R 91 <br /> O <br /> y M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my L7 c ID <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of i mC <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CD <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- oG, 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 m <br /> providing in this plication. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized pens to ccess to the above described premises atMigipo f the purpose of inspection. m <br /> pL <br /> KCUCIVCI <br /> m : <br /> m : <br /> SIGN HERE — ( — `p f i i ff2 <br /> signature of ow or Ilding contractor (date) <br /> ZONING ADMINISTRATOR1-164 <br /> Gi i i <br /> wcnv+v+vr <br /> N0MMC> <br /> TOWNSH PERMITS MAY U OOUNN v o u, In o <br /> 0 0 0 0 0 <br /> 0 0 0 0 0 <br /> ZONING <br />