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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 PERMITSi7 0 <br /> 3. <br /> OWNER LiE'/F 6'XA457LUA lI,v (! -411 LA6R TELEPHONE 7/,j-,Z:5 -?2 6 6 0 <br /> HOMEADDRESS 3LOI Gef:AT 3E." -rZg1tiWFly AMAJe9 101' 5yf�3v Ow <br /> EMERGENCY/FIRE NUMBER <br /> � 7 ROADNAME 6,ee4r 43F-4p- <br /> LEGAL <br /> 3FAQ <br /> �{ l l <br /> LEGAL DESCRIPTION(see tax receipt) .SES�3 / QA) )el.! w �� �� i� a Pa <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ® PRIVY ❑ ( 0 <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ �. <br /> STRUCTURE/ADDITION USE: — IN 6OFF 0 <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) <br /> BUILDING CONTRACTOR: <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN fiY:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) c <br /> O <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE y o <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDINGS)TO ALL LOT LINES,(B)BUILDINGS)TO m i�v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF I 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 C <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. ° <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN a <br /> V 1( tl <br /> S <br /> NEEDED. I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <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. <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 /> SETB,A.C•KAREA. �^ /�p , <br /> a m C <br /> 6. M M O <br /> �- <br /> O <br /> 7. � : <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ZS C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of n iT <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize f° M m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ? G <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 E 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. - <br /> m <br /> SIGN HERE <br /> (signature of o,,fne�rr000rr bbulllding contractor) (date) <br /> ZONING ADMINISTRATOR )�r(J r— `( OCO) <br /> TOWNSHIP PERMITS MAY BE REQUIRED0000 <br />