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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 /> N O r� <br /> OWNERZQ//y �,6 TELEPHONE <br /> ` <br /> HOME ADDRESO <br /> S • 41V3 �, CeC1c//t �y 1�� -�llJ'l`O/` �.tJr �y��� r <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> G /7 w <br /> LEGAL DESCRIPTION(see tax receipto^ CD <br /> a <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ C) 0 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n5. <br /> " <br /> N <br /> STRUCTURE/ADDITION USE: -3a x10Q <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) y <br /> m <br /> BUILDING CONTRACTOR: A,, ld &ilo/en-5 0/1e, G <br /> v <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. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O c <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m �? <br /> NORTH(N). <br /> n <br /> y� <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO mv 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> NCNI <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 Sb <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED. 0 I <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. J ( <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 /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK <br /> /�AREA. <br /> 5. /�J�^_ / <br /> C) r oCD W �ov <br /> 6. amc "v o�' M <br /> 7. Z : y f° o�c o0 1 <br /> o .0 <br /> CO <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my [j c p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy ofCL <br /> m' C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize �`) m rn <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- t7 <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 m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T <br /> m <br /> SIGN HERE �1z,10 ' <br /> (signature w rorbuildingco tor,)) (date) O <br /> ZONING ADMINISTRATOR1W W W 40 69 <br /> 1Y N N0NN0 N <br /> a� VV M (nPC" LnO <br /> TOWNSHIP PERMITS MAY BE REQUIRED �t7 Iq q 0 0 0 0 ' 8, <br /> 0 0 0 0 0 0 <br />