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U W <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,W154872 Office of Zoning Administrator 0 o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> m � <br /> m <br /> c <br /> m <br /> OWNER Yoh",. <br /> TELEPHONE <br /> m <br /> m <br /> HOME ADDRESS 13Scy As-os O <br /> r <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME &1cxy' <br /> et�,z.t! <br /> LEGAL DESCRIPTION (see tax receipt)e 9"',d Se -7 /e,*e Y4 Al <br /> A" S f ,, <br /> W <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION W PRIVY ❑ (n 0 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> N <br /> STRUCTURE/ADDITION USE: o y' -?-4 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) co <br /> r D � <br /> BUILDING CONTRACTOR: f s yEr n A YL d' <br /> CD <br /> CD <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. T <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO rn B <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <br /> kA <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. o f <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATI MAY BE DONE WHEN o l N <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. /S Z <br /> CONDITIONS OF PERMIT: P w <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS RMIT <br /> ISSUANCE. <br /> [` <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHOE e,, <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY r / COU <br /> A� <br /> PERMITTED, ZOW�(�^IG rYJ-/ <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATERrG <br /> SETBACK AREA. n,, - n , ' <br /> 0-6 1�� �^�JZ/ a <br /> CD CM. � � ao :E m <br /> 6. d �a�-OJ'f�' 0 B a m s a 1D <br /> 'a m C N o 3 <br /> 7. o y T2 <br /> = rn : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my n 0 2 A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of �> m a m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <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 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. CDm <br /> CD <br /> // m <br /> SIGN HERE <br /> sI ature or building contr t I (date) <br /> ZONING ADMINISTRATOR <br /> `(6 <br /> TOWNSHIP PERMITS MAY BE REQUIRED �SbD <br />