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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 7 _V 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N � <br /> N <br /> C <br /> OWNER <br /> C�/AhL G� � � /< TELEPHONE 716 �--7 <br /> m <br /> HOME ADDRESS <br /> m <br /> 0 <br /> EMERGENCY/FIRE NUMBER �I ROAD NAME /�ilA/s//t/b A fG� /✓/2 <br /> �` 1 <br /> LEGAL DESCRIPTION (see tax receipt) Pj CL � � 138 -1� � <br /> DWELLINGIBUILDING,�R GARAGE/ACCESSORY STRUCTURE 1:1ADDITION ❑ PRIVY ❑ o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> N <br /> STRUCTURE/ADDITION USE: y4MEfC.ALa/� <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: 1444 Or,,/01T/G(J�7/D ti " F t <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> ;a N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n C- <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <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 1 <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. o <br /> O0. O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 <br /> NEEDED. n !� <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 ( Q <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 AR A. <br /> 3 �f a r� anCe� - 30' Ske d -a OLM <br /> CWr0OQ : M <br /> 2 3 o. m xn _ ;d <br /> 'O N C y N O = 3 <br /> pi T� <br /> — U) AI declare that this application (including any accompanying schedule) has been examined by me and to the best of my 2 : c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of 2 m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> CD <br /> that this information I 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 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 I <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. fD <br /> m <br /> ID <br /> SIGN HERE i N 2j ;2-oZ>/ 69 <br /> (signs o owner or building co or) (date) <br /> ZONING ADMINISTRATOR <br /> WNSHIP PERMITS MAY BE REQUIRED �2C� <br /> L(—atp- 0 <br />