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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning AdminisratoT r v G) z <br /> APPLICATION FOR LAND USE PERMITS 3° <br /> r <br /> OWNER `� (1 n� 1 TELEPHONE <br /> HOME ADDRESS �`�,�ao !^et.U 0 VG{Vt�iJ IG / ,& l� 60.5 fD �U1 <br /> ` r m <br /> EMERGENCY/FIRE NUMBER ,r�9 �Q( mG l,, `f N,(, ROADNAME � <br /> LEGAL DESCRIPTION(see tax receipt) �� /�( 5i c &e �J1���/✓/✓�jUf1 1L_ <br /> U) <br /> n <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ rn 0 <br /> TYPE OF PERMIT(S): <br /> c <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION ❑ CL <br /> STRUCTURE/ADDITION USE: 5f�t�P H - -I <br /> (Home/Cabin; Commercial Busii�oess; Bedroom; Deck; etc.) y <br /> 93 <br /> BUILDING CONTRACTOR: tr'i� u i lJP V, 1 r 1 t if <br /> U V <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR O 3 (D <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> y n <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) p m <br /> ?r o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m X <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N -C <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'o o <br /> o a <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHENw <br /> NEEDED. Er ILn <br /> '• I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> CONDITIONS OF PERMIT: ° <br /> v� <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 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> m m r D p L 0 -0 <br /> [i <br /> 6. F � vCL0CL m <br /> 10 <br /> •m c m : ' 3 <br /> 7. z a � q <br /> o : <br /> o):'r <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c : p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m 0 c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- O <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relFi4, 1,r�rmatlon I amproviding in this a lication. 1 a to p rmit county officials charged wi i i Sbk other mauthorized person have ccess the ve desc ibed premises at any r n pl m i per tion. T C <br /> SIGN HERE p � <br /> (,signal a of ow er of building contractor) A date O:, <br /> ZONING ADMINIS ATOR V , I� _ _ f `/J~j <br /> ' TONING cNii N o ,cNii pNi o 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 00 0 0 0 0 0 0 <br />