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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 4 <br /> r o \ <br /> OWNER �V �'��- FX 72 <br /> /.1. <br /> HOME ADDRESS ZZO 37R.4P,N /CDS, W't//TC E, AN. W-11pCD <br /> v <br /> / o <br /> EMERGENCY/FIRE NUMBER �Z�3 ROAD NAME C oLt.tlTt�l �/7 I' <br /> LEGAL DESCRIPTION (see tax receipt) S /T x1b/%Z& uJ O'T 2 CSm 6 13v <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ I u, <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) m <br /> m <br /> BUILDING CONTRACTOR: IQGf S.fw Er <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> ;7 tzz <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m (1� 33 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m y J O <br /> NORTH(N). to 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO fn <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF U ` Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. A <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. I `z <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. ) m o <br /> V1O ) <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN � q S <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z° <br /> CONDITIONS OF PERMIT: q <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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 1� <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 751 OL 1-4::1 <br /> 2L.9 M <br /> 3a o m <br /> 6. v n; Cuy y ° N <br /> 7. p N R '10 q <br /> (n m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Zj c C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ' ;a <br /> m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 Qt m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other I�N ; Co <br /> autho ' ed person,1q,have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> m : <br /> nr <br /> SIG ERE <br /> (signal re of owner or build ng contractor) (date) <br /> ZONING ADMINISTRATOR w <br /> wwwwwfn� <br /> N N fr1 N N°1 fJ1 <br /> fT N O fr1 (J1 O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 <br /> 0 0 0 O o O 0 <br /> L� <br />