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C�yl- 6� <br /> BUrnefi r'ounty 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator -0 C) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N <br /> C <br /> N <br /> OWNER /L,j LL i4TELEPHONE <br /> m <br /> HOME ADDRESS /C) �Ll �r N�2 ry jL�L /��/ �*. •I�l S ��/c 3 v <br /> EMERGENCY/FIRE NUMBERROAD NAME m <br /> LEGAL DESCRIPTION(see tax receipt) L �I C� <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITIO PRIVY El N 0 <br /> TYPE OF PERMIT(S): o <br /> or <br /> / <br /> FILLING/GRADING CAMPING UNIT El SUBDIVISION ❑ /1/ / L1 ` <br /> d S. <br /> STRUCTURE/ADDITION USE: scr s e-F- � lh j�Q HG H O-t. F Y i S i �wq /SEC t 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck,etc.) �L�1� ca <br /> BUILDING CONTRACTOR: Q �i'�r r=k CgrrJF_ <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> 0 in <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p m <br /> -n cL L <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. In \ Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C ° O n� <br /> NORTH(N). <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. c <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. rat <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ' ` ri <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS v <br /> MUST BE SIGNED AND DATED BY THE OWNER. co <br /> c <br /> o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHENa °, <br /> NEEDED. w <br /> ppv' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z IJ <br /> CONDITIONS OF PERMIT: p <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. I I <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY v <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. � <br /> 5. /n�X SIZE d� Por [ <br /> t� �e / <br /> -a n r p O O m <br /> s. �P�ti SCrne,.- Pow/ 0n Lc, , Njf 71G �9e �/��a��rr� Ll�l K� /4 2 4 °' C tQo RL y� <br /> I' V 3 c. <br /> 9 mCy !" o� 3 <br /> 0 <br /> 7. z " m <br /> o <br /> szi,Er m <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my ,/yam dj p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m E � i C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize U: m m m <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 d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other d m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. T <br /> M : <br /> M : <br /> SIGN HERE '� T✓Y _ /y — <br /> (signa re of owner or bulIV9 contractor) (date) <br /> ZONING ADMINISTRATOR <br /> fncntnwww <br /> �+ <br /> 4N NOS NN(r�(T <br /> p N O o p O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />