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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v c) Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> i, O ` �l <br /> OWNER �- a <br /> TELEPHONE �`_ L�f"g_Q"C� <br /> HOME ADDRESS Y7e2 i6N-WRY 70 0 <br /> r- <br /> 0 <br /> EMERGENCY/FIRE NUMBER V762 ROAD NAME 6Gd zgY '70 <br /> LEGAL DESCRIPTION(see tax receipt) ((��OJV F' o l' 1�t/4/J <br /> � <br /> USI <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ `v!m <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING El CAMPING UNIT El SUBDIVISION ❑ v <br /> CL <br /> STRUCTURE/ADDITION USE: 901le /C19-FIV <br /> /A/ tu4k4t t~ �tV'1° /"* -fZS) <br /> (Home/Cabin; Commercial Business; Bedroom; Deck"etc.)etc.) y <br /> BUILDING CONTRACTOR: AM,4q- nWN� <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE O� �r 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> � _( O S�„pr Q1 c <br /> Zt6 F- y N <br /> QIBECTIOtA FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) $ O o 'rter <br /> n T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. mID M <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n't <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m Om <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. 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. Z N r <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS �D <br /> MUST BE SIGNED AND DATED BY THE OWNER. c <br /> to 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN C <br /> NEEDED. Q, <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: a ) <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 N <br /> PERMITTED. (lVy�l <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER d <br /> SETBACK AREA. <br /> 5. <br /> ;a n? �, L <br /> 6. m � '3 A <br /> D i R C N y O 5' 3 <br /> 7. Z <br /> O • N Z�'< i <br /> CD: <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c 10 <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of C C <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize k CD <br /> PP ( 9 Y ) 9 F CD <br /> C . <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- p <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 p rmit c my officials charged with administering county ordinances or other �� ; m <br /> authorized person to hav ccess to thpftfive 04jicribed pr ises at any reasonable time for the purpose of inspection. -n <br /> m <br /> p <br /> SIGNZG <br /> (signat a owner orbul tractor) (date) <br /> ZONIINISTRATOR <br /> N N N N N N N <br /> VI 01Out U1OO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />