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Burnett County 7410 Co. Rd. K, No. 102, Siren,W154872 Office of Zoning Administrator - o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> f/1 <br /> C <br /> N <br /> OWNER Y1 QT 1 O r h � TELEPHONE <br /> lJ m <br /> HOME ADDRESSa° 651 10 Oda t- Pf R j• G-rovr,'+56 �1A (� <br /> I�rG I Sggq 0 " 1 <br /> r m <br /> 0 <br /> EMERGENCY/FIRE NUMBER a bs�b ROAD NAME C ealb_ <br /> s d 9l 7 3 7pap W <br /> LEGAL DESCRIPTION (see tax receipt) 3 7_Ig Zq p 6 39 o p iU 50 f n�' l.5 Sa S Al W O <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE © ADDITION ❑ PRIVY ❑ (/> <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ �, �' <br /> STRUCTURE/ADDITION USE: 54-tt ,/r`Q a .a— /��Z <br /> ( me/Cabin; Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: 5 L I <br /> m <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 ' 1 1 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p '- W <br /> rw <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) OT n <br /> T 0 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> C o <br /> NORTH <br /> 3. SHOW D M)ENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> v <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. ° <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. ( 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. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN J <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o O <br /> CONDITIONS OF PERMIT: w <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 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> n D C M <br /> f <br /> 6. a m C c o 3 <br /> Z : CD <br /> 7. o : T m <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my 0 A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of n <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize a fD mm <br /> that this information 1 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 Co Burnett relying on this information I am <br /> providing in this application. I agree to permit county officials char county ordinances or other <br /> authorized person to have access to the above described premises at'' a ose of inspection. .n <br /> � j C : <br /> SIGN HERE <br /> Sig ur of owne r ildIng contractor) � atie <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQ�R�(y VN7Y <br /> V <br />