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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. <br /> r <br /> m <br /> m <br /> m <br /> `/ o <br /> .OWNER f - r, TELEPHONE a�.d < j <br /> m <br /> 0 <br /> HOME ADDRESS J <br /> � /J?� C1 `Tp`j`j :d/7 Le ( G� �V ✓ �' r <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> 1 <br /> LEGAL DESCRIPTION(see tax receipt) !2' 3QG/ ,y C, <br /> (OVyyl o <br /> DWELLING/BUILDING El ��'( ❑ � <br /> GARAGE/ACCESSORY STRUCTURE 1�J ADDITION ❑ PRIVY <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING <br /> f F-1CAMPING UNITE] SUBDIVISION ❑ m. <br /> STRUCTURE/ADDITION USE: 4101" A( ✓ ���d��' <br /> ome/Cabin; Commercial usiness; Bedroom; Deck;etc.) C <br /> BUILDING CONTRACTOR: <br /> 0,217 L 4 L,:595L-Z V <br /> T <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) -n o. <br /> n z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. z c� <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m c� <br /> NORTH(N). ° <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF v Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 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. y P <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 1 N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS o O <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o 1> <br /> CONDITIONS OF PERMIT: <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. I <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 /> S0jr- <br /> T <br /> 5. b--I"1/; p�' )-D -0Or v�v 'C <br /> co 1.y ') � a <br /> 6. g mcu" a5' 3 <br /> N N <br /> : <br /> 7. O �M'< <br /> _ <br /> = ur : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G3 c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy ofc IF <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- v <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 Amises at any reasonable time for the purgose of inspection. T <br /> CDm <br /> SIGN HERE <br /> (slgnatur o ner or ullding co tor) ,( ate) <br /> ZONING ADMINISTRATOR ! fn V+tN w <br /> N ri L" V7 <br /> V N O V N O O <br /> TO SHIP PERMITS MAY BE REQUIRED <br /> O 0 0 0 0 0 0 <br />