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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3` <br /> UT <br /> N <br /> OWNER r-24nru �'� JJQX'�1�rn. 'l�L2CK/( LEPHONE 7!S-8h�-7375/ v <br /> p D m Qn <br /> HOME ADDRESS ag 793 - 'Q�P�' �q� �G Lb of 4 LlJ I SAI( 3 d v O <br /> ^ G <br /> EMERGENCY/FIRE NUMBER of g-1 93 ROAD NAME <br /> N aA4 Rds o-F JE 3'y Rd-5 ISI W NW ' <br /> LEGAL DESCRIPTION (see tax receipt) SeC� <br /> 14 ._-r4o n '16( CCn <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE X ADDITION ❑ PRIVY ❑ (n <br /> TYPE OF PERMIT(S): r ' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION El <br /> N <br /> STRUCTURE/ADDITION USE: 0 <br /> (Home/C in; Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: SLITr42 <br /> 0 <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8Yv X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> 3 r14 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O Q <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m �° <br /> NORTH(N). <br /> C o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m 3 <br /> a <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. N <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. f <br /> O � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN o (� <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT C'>. <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 /> 1`LJI�1`. ; v 0 r> 0 >0 M <br /> d f m <br /> 6. COD <br /> N N N N ? 9_ <br /> N N O 0 <br /> 7. O T� <br /> _ �l <br /> — : ID <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of QLD', n <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize pP ( 9 Y ) 9 : m ; p <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> CD <br /> authorized person to have access to the above described premises at of inspection. m <br /> CD <br /> m : <br /> SIGN HERE <br /> (signatu f ner r building contractor <br /> ZONING ADMINISTRATOR �n <br /> TOWNSHIP PERMITS MAY BEREQUIRING <br /> QUI INGl11V' d <br />