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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administratoro 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N <br /> C <br /> OWNER �'� TELEPHONE n <br /> ^ 1� <br /> HOME ADDRESS d aLj� 09- <br /> bJr, CtWj Loot ctKpUy ��( /�r Sy�i3u �r <br /> EMERGENCY/FIRE NUMBERROAD NAME // 1 <br /> a9c'lY�o Lrrf to W; /dwuck� �axv <br /> LEGAL DESCRIPTION(see tax receipt) 0 <br /> C's h--) V / �l Q e)_ ti <br /> c <br /> DWELLING/BUILDING El GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ U) <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> �i <br /> STRUCTURE/ADDITION USE: V"0.�Q�IV c� i SIC a�I Co )C�tl Q PL 0 n <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) ur `l <br /> (� m <br /> BUILDING CONTRACTOR: <br /> CD <br /> I U h <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR T <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C1 obi ~ <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C ° n Q_ <br /> NORTH(N). rn c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m \ 1 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Cy .Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. J P <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. Q <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 MAYBE DONE WHEN q <br /> NEEDED. <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 <br /> ISSUANCE. I O <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 /> PER <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER SL <br /> SETBACK AREA. d <br /> 5. <br /> M <br /> -Umd vDnov <br /> 3 a M 2- n � <br /> 6. m � r <br /> fP C N y O <br /> 7. IWD <br /> C N �m <br /> = CO m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my rj p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognizeCD <br /> ;U <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 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 <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. -n <br /> m <br /> m : <br /> cn <br /> SIGN HERE - D <br /> (signature of or bu ding contractor) <br /> w er odate) <br /> ZONING ADMINISTRATOR <br /> N ! (PNNf7 P <br /> 4A 40 W 40 49 <br /> ut N O V7 V7 O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />