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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator ' o 0 <br /> APPLICATION FO LAND USE P RMITS 3. <br /> li a Ll.Q <br /> �� ) LOS 45�-7 '27 2 0 <br /> CD <br /> OWNER M. KeCL <br /> Mc Monaq(e, fac ap � TELEPHONE r7Ib_ bgq - 290 LP v �s <br /> HOME ADORES q5�3 1Dusiko= (A1Le, Drt e- /110 31ue, Heroh a <br /> m <br /> EMERGENCY/FIRE NUMBER q 5 7 3 ROAD NAME Dt,LnNtam [tAja Dr <br /> LEGAL DESCRIPTION(see tax receipt) <br /> Gm <br /> DWELLING/BUILDING 11GARAGE/ACCESSORY STRUCTURE ADDITION ® PRIVY ❑ m o <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ o- <br /> STRUCTURE/ADDITION USE: Z bedrooms , l ba+h room <br /> (Home/Cabin; Commercial Business, Bedroom, Deck;etc.) ti <br /> d <br /> BUILDING CONTRACTOR: '- <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. "n <br /> 0 y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p m <br /> n o <br /> -nZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n Wo � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m ED <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m \ 3 C> <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. P V.1 C--\ <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS I 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. a <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <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. n y <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 /> 1907 SCY'ee/J vo" td(�e •�'oN(. �"7� OPeN A� � <br /> " � wd0iDnf m <br /> 6. /� �-� !oe° lo-f �caab '� = /`f 9� `� ' �.� a ; a A <br /> .Q N O (� ? 3 <br /> �` ��,►'1.eRat E�lZd�rl� '�DWT / PS 'n'< m <br /> I declare that this app cation (including any accompanying schedule) has been examined by me and to the best of my G) c ' C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m 0 m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognizeCD <br /> 0 <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 <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 m <br /> �/�/ }�' ! m <br /> SIGN HERE 2�LG'"�'•,/�-J/6�l: -'f 7 r l l o <br /> ss <br /> (signature of owner or bedding contractor) (date) (� <br /> Q <br /> ZONING ADMINISTRATOR �/ l_U m F)C-)ZIG�c� <br /> ) <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />