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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 <br /> APPLICATION FOR LAND USE pERMITS CD 3 Office of zoning ,ad Is '`�'trator C o <br /> < <br /> OWNER Ae, -t FA&�GgS I) Imo/ TELEPHONE <br /> J f7 961 x(30 3Oq'� o -� <br /> HOME ADDRESS ` tyd Ay E ki 1, r4"o 3'�wCD <br /> FO <br /> EMERGENCY/FIRE NUMBER ROAD NAME I EN 1 0 /v <br /> Go�vb - cAttc <br /> LEGAL DESCRIPTION(see tax receipt) HI-YDr�u AZC L si- � C� <br /> © T 0 R I � frit <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY .. <br /> TYPE OF PERMIT(S): y 0 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ sTR'1RS 'rO W�1TrA a <br /> STRUCTURE/ADDITION USE:_ 9 T/}►F1$' j L F}A1Dt//A, JI(f/1(r S_TE�,� <br /> (Home/Cabin, Commercial Business; Bedroom; Deck; etc.) <br /> '` ' In <br /> BUILDING CONTRACTOR: T 144 F, <br /> /}til Azle- 'z -a <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> 3.O <br /> DIRECTIONS FOR PLOT PLAN DRAWING• (AERIAL OR TOP VIEW) I Q <br /> O m <br /> O. <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m o <br /> NORTH(N). C <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 \ " <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO o <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. � <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS o v <br /> MUST BE SIGNED AND DATED BY THE OWNER. g. o <br /> o t <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I <br /> ISSUANCE. O <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. D <br /> 5. V <br /> -U n r D C D 0 -0 <br /> 6. m v m o m a f m <br /> m `c 3a (OD O� Lm <br /> "o CD C y c' O Ei 3 <br /> 7. Z : N o <br /> Elfflimf <br /> that this application (including any accompanying schedule) has been examined by me and to the best of myCne and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of Q d ation contained in this application(including any accompanying schedule)and I further declare that I recognize Cminformation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- mmit. I further accept all liability which may be a result of the County of Burnett relying on this information Iamm in this application. I agree to permit county officials charged with administering county ordinances orother <br /> d person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> CD <br /> m <br /> SIGN HERE ' a CD <br /> (signat a of o e,�or uilding on c ) (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />