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0he <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> OWNERr — f GQ TELEPHONE ' j n <br /> L11a) <br /> Z4 OF &2sE5 Pso 2t � <br /> HOME ADDRESS of Z p s .� bq V fJ h i. � � <br /> T 1 <br /> EMERGENCY/FIRE NUMBER -7 Oa S7 ROAD NAME 1 07 e f to <br /> 60 d LdT' / crS m 6ra3 C -5 Nt <br /> LEGAL DESCRIPTION(see tax receipt) C SSM S U a fps . /73 a 01.7 Cs"I U S -S9 6 3 <br /> P C <br /> In a 7 P45- fWin <br /> 0 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ co <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNITElSUBDIVISION L <br /> D /,^, �� ❑ <br /> STRUCTURE/ADDITION USE: O nn <br /> /` [�//� I 0 <br /> (Home/Cabin; Commercial Busigess;"$edroom; Deck;etc.) <br /> O " ' m <br /> BUILDING CONTRACTOR: O r R <br /> _ O 2 Q Gc v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. nR <br /> 0 in v <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> T Cl <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). C o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)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. 0 <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. o <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN _fes <br /> H 2 r <br /> NEEDED. U.t <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <br /> l <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 ( J <br /> PERMITTED. tt"wVV11 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> zv0r- 0 <br /> �. m � mn m <br /> m C N y o 7 <br /> 7. Z N �� <br /> O <br /> € m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognizem ;a <br /> that this information I 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 relying on this information I am m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <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 HEREAE <br /> si nature of own building tractor) (date) <br /> ZONING ADMINISTRA OR d, <br /> N NNNNCn (J1 <br /> V7 V1 ON NOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 <br />