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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrato o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> ; O <br /> OWNER TELEPHONE-7/J-: ,a 6.!? —337'1 <br /> HOME ADDRESS SG r <br /> r m <br /> 0 <br /> EMERGENCY/FIRE NUMBER /Q �� �4 ROAD NAME '0A �G �1 <br /> LEGAL DESCRIPTION (see tax receipt) sew �Z/e cherA col <br /> 0 <br /> DWELLING/BUILDING 1:1GARAGE/ACCESSORY STRUCTURE El ADDITION <br /> ADDITION L^4 PRIVY ❑ N- � 0 <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION ❑ CL <br /> S. <br /> STRUCTURE/ADDITION USE: �At2f�C�JC /Ll V 1(1(l NOZ7YT�� MTl 0 <br /> (Home/ abi Comnhercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: O a✓/1 N cn �e n j 6f <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR n 3 G <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. vJ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n <br /> TI 0 !� Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C <br /> NORTH(N). y <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m �kCN <br /> 3 <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. 1. <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> 06 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q <br /> NEEDED. (� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: .-� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. J <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER \ <br /> SETBACK AREA. d <br /> 5. <br /> zCD � l ; oCov <br /> M CD CL nn <br /> 6. OLD.'< vo. 0OXa - 3 <br /> v M C N 0 0 <br /> 0 <br /> 7. 0 "� 1 <br /> � : <br /> - m <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o g <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m 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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other CD <br /> 0 <br /> authorized person to have ac ss to the above described premise 'at ea e time for the purpose of inspection. <br /> Ir m <br /> (D : <br /> SIGN HERE <br /> Is ero buildin coptractor) (date) <br /> ZONING ADMINISTRATOR <br /> cn w w fn Fn v+ <br /> N NNNNN (T <br /> (3U r Ul U1 O N VI O O <br /> TOWNSHIP PERMITS MAY BEZRE MaD 0 0 0 0 0 0 0 <br /> 0000000 <br />