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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator -V OZ <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> OWNER J D h I I l^'rJ TELEPHONE <br /> HOME ADDRESS 1/Dad Glen (41j)V)1'4 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME Sa-)?4::/ <br /> LEGAL DESCRIPTION (see tax receipt) 0 yJJI I D -7$ V C, I C5111 V 16 )0 3" y <br /> CD <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ GOPl tj rn <br /> TYPE OF PERMIT(S): <br /> I Cr <br /> FILLING/GRADING CAMPING UNIT ❑ SU%DIVISION ❑ <br /> 5. <br /> STRUCTURE/ADDITION USE: a (\ . <br /> 0 �J <br /> (/Home/Ca n; Commercial Business; Bedroom; Deck; etc.) rn <br /> BUILDING CONTRACTOR: Jd hh (�/ l�cr�� <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 6'/s X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T0 <br /> M y <br /> DIRECTIONS FOR PLOT PLAN DRAWIN • (AERIAL OR TOP VIEW) 0 m <br /> n CL \ <br /> -n �\ Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m ;? <br /> NORTH(N). C O <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> o <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ff ' I <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO W <br /> BUILDINGS,ROADS,LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS I 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o l <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 <br /> NEEDED. o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT (1 --4t D" <br /> ISSUANCE. /1('iJ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. bppp� I <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ^ �G <br /> PERMITTED. td� <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. IP <br /> Q 5 ' o t � I U } � y/V <br /> 6. 0 K��OLtwcJ "115, or o l^+^ 5-hr.-v, w,H I �� + 6"' d.t4W� 1 ,5 a 'o in �' EL <br /> 7. !icow !' op O <br /> Na,yw0/, ck0 <br /> 3 <br /> m <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of `�' m � : C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize a <br /> CD <br /> Io <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 courq officials charged with administering county ordinances or other 3 <br /> CD <br /> authorized persop4o hqqe access to W above des (ipremises a any reasonable time for the purpose of inspection. <br /> T <br /> W <br /> W <br /> SIGN HERE <br /> is natur ofowneror 1101 contractor) (date) <br /> ZONING ADMINISTRATOR <br /> 69 <br /> N NITNNNN <br /> p1 pl O fT (r O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />