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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator - o° o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N OT <br /> M TELEPHONE \ � <br /> OWNER �L. fi SAGN�s ��I')'1��-37'l� of <br /> HOME ADDRESS I �� 27 rnfl ����oo � rnll� � I 0 / r m <br /> O <br /> EMERGENCY/FIRE NUMBER (3 l O ROAD NAME �� 1 pLt) JR <br /> p p 1 P <br /> LEGAL DESCRIPTION(see tax receipt)SQ� I 1 1�h,Q 3� I f��y1gC l o , pT ) M <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ,� ADDITION PRIVY ❑ c <br /> TYPE OF PERMIT(S): n ' <br /> FILLING/GRADING <br /> ^1:1CAMPING UNIT 1:1SUBDIVISION ❑ <: <br /> STRUCTURE/ADDITION USE: l a. x IID STo Ra(M E SH eA C" <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) U (� <br /> BUILDING CONTRACTOR: �+ <br /> (D 1 <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> ."f7 (D <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> -n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m vPO <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> ASC <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m i o <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF V <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 1 ° <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 O. <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 /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN T ° <br /> NEEDED. (tea <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o vn 7 <br /> CONDITIONS OF PERMIT: ��J <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. C <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 ' o«f �(� <br /> 6. — -f a CT-Z- <br /> V NEON � "I <br /> 7. T <br /> �l�c LYj G���/ l� o m <br /> - � <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) D <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of a <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize CD <br /> ( 9 Y ) 9 `D p <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> C) : <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 /> authorized person to have access to the above described remises at any reasonable time for the purpose of inspection. T <br /> M <br /> 69 <br /> SIGN HERE a �O <br /> ae o <br /> (signatu a of ner or ilding co ac (date) <br /> f ,� • _ r }U <br /> ZONING ADMINISTRATOR <br /> 't <br /> V <br /> TO NSHIP PERMITS MAY BE REQUIRED '�`C_ <br />