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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator v Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N0- <br /> OWNER <br /> OWNER TELEPHONE <br /> tJ J J ❑ P <br /> HOME ADDRESS / ��"� v�/ / CD <br /> r <br /> EMERGENCY/FIRE NUMBER / ZIS' ROAD NAME <br /> , —�--a� SOU' -a6ro <br /> LEGAL DESCRIPTION (see tax receipt) SG '1 1 Aged, /�5 �/S 46 seo ��� g�C� O <br /> TYPE OF PERMIT(S): <br /> DWELLING/BUILDING ElGARAGE/ACCESSORY STRUCTURE X ADDITION 1:1 PRIVY ❑ <br /> FILLING/GRADING ❑ CAMPING UNIT <br /> ❑ SUBDIVISION ❑ a � <br /> STRUCTURE/ADDITION USE: Q ;��KS /X Ty m <br /> o' <br /> (Home/Cabin, Corrimerclal Business, Bedroom; Deck; etc.) U <br /> BUILDING CONTRACTOR: � y <br /> d 1p1 <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/z X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m 3 <br /> O Zp <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) <br /> O m` <br /> T a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T ? <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m ❑ <br /> NORTH(N). <br /> m <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m 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. CC7� <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 <br /> 0 <br /> NEEDED. 0 I <br /> �^ O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o - <br /> CONDITIONS OF PERMIT: �S <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 SHO REOi' <br /> n , <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY,' <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE RE REDWATER <br /> SETBACK AREA. <br /> 5. Fft <br /> CDM6. BURN C D i a n (D 0 � <br /> 7. �4NIN 1N ID y ^ o Ei 3 <br /> p N CD <br /> CD O <br /> G <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C)c C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m` <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- CD 0 <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 w <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. rD <br /> m <br /> CD <br /> SIGN HERE F» <br /> -02 —Dc) <br /> (signature of owner or builtling (date) <br /> X <br /> i N <br /> ZONING ADMINISTRATOR I <br /> TOWN HIP PERMITS MAY BE REQUIRED <br />