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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator ' o 0 <br /> APPLICATION FOR LAND USE PERMITS _ 4 <br /> T J 41 <br /> OWNER /ah ,F C1 U.ff V AHd erson TELEPHONE <br /> HOME ADDRESS aaLq ?(l /el �Cea ejZ /40 S-5-a 22 v <br /> 0 <br /> EMERGENCY/FIRE NUMBER Pit # 23101 ROAD NAME Old 35 <br /> LEGAL DESCRIPTION(see tax receipt) c"t & ! c3 3-38—) 7 Q <br /> 1 ❑ ADDITION ❑ PRIVY ❑ <br /> n <br /> e <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE rp o <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ ' <br /> //n U N. <br /> STRUCTURE/ADDITION USE: /7eoter/(^tivII ic-;? ""H x,3 ,Q <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) _ U) <br /> BUILDING CONTRACTOR: h!an A Aiderropt -- Er <br /> I ma <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/Y X 11 SHEET OF PAPER. ANY INCOMPLETE CR O 3 <br /> c <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. ` 46kS LkrTIr-J <br /> Ottc,ln e-v% WIEd SlAmw-ski O m o0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n o. <br /> -n o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO IM <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. ° <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. C <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. O <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. 1Jo 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN `'' Cr (1 , <br /> NEEDED. XJ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o q J <br /> CONDITIONS OF PERMIT: 1� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I I <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 OO <br /> SETBACK AREA. <br /> 5. -0o0imimti0 q <br /> 6. fD v a '" <br /> Nm <br /> O <br /> : <br /> Z <br /> O <br /> 7. y m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my (M G� C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofn E' <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize C" m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m O <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 counV officials charged with administering county ordinances or other m <br /> authorized person to have cess to thWboveAlilisclibed premises at any reasonable time for the purpose of inspection. m <br /> m : <br /> m : <br /> SIGN HERE <br /> (si at a of owner or u' ing contractor) (date) <br /> ZONING ADMINISTRATOR <br /> N N (IINN V1(T <br /> (lNOUt UtOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />