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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administratoro 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> 0 <br /> N O <br /> C <br /> fD <br /> k�tz <br /> OWNER �. TELEPHONE <br /> (j HOME ADDRESS OI���{ �, 0 � <br /> m <br /> l 0 <br /> EMERGENCY/FIRE NUMBER y� ROAD NAME G j Icy GS/lC \ r <br /> 410 <br /> LEGAL DESCRIPTION (see tax receipt) �r� L 3 C L.a K� �G�1 � M <br /> ° <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE P ADDITION ❑ PRIVY ❑ ° <br /> TYPE OF PERMIT(S): c J <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑� � L; <br /> STRUCTURE/ADDITION USE: �4 4 C ° <br /> (//Home/Ca ; Commercial usine'ss; Bedroom;Deck;etc.) (nBUILDING CONTRACTOR: yyr✓G 411,nJ / s' <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR I ` <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) OQ <br /> T a Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m d <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C o <br /> NORTH(N). y <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDINGS)TO ALL LOT LINES,(B)BUILDING(S)TO m ` v <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. P <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. 0v <br /> 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN a ° <br /> NEEDED. C <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: 1 <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. /. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Q� ^ <br /> PERMITTED. I+ l•'7T <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. n_ / / <br /> � / <br /> 5. �� <br /> 100vP r, UN t o u <br /> /� �G Q 0YLjr On m 'a a. �9 m <br /> . <br /> Q�pll�cf< OY Qh ' m c m ° o 3 <br /> N OCo <br /> h _ cam,` 0 ZM <br /> 7. an C2 2 +' . = rn <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined b)7 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 <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- m <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 o ty officials charged with administering county ordinances or otherm <br /> authorized person to have access to It ab a ribed premises 2t: reasonable time for the purpose of inspection. -n <br /> CD <br /> m <br /> w <br /> SIGN HERE <br /> (signs o ner or building con cto (date) <br /> ZONING ADMINISTRATOR F»vi f»fn f»w <br /> N N4AN NOON <br /> N fT OfTN00 <br /> -V0000000 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0000000 <br />