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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> y O <br /> OWNER TELEPHONE <br /> �a tV 1 y L <br /> ^►'.(( i C 1 / T m �/i <br /> HOME ADDRESS / Y1 L �� ,� A.10rJ IF lL 475/ v <br /> EMERGENCY/FIRE NUMBER ROAD NAME 1) / <br /> ri <br /> LEGAL DESCRIPTION see tax recei t ♦ .{-$ �/F k <br /> ( P) �s�o �l NErIa: =�nr � 14EArn [)a CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITIONPRIVY ❑ c 0 <br /> TYPE OF PERMIT(S): <br /> Cr <br /> FILLING/GRADING ❑ CAMPINGajijm!�, <br /> T ❑ SUBDIVISIONE] <br /> STRUCTURE/ADDITION USE: C N0 ifs Atea / _ <br /> (Home/ bin; Com rcial Busi ss; Bedroom; Deck;etc.) m <br /> m <br /> BUILDING CONTRACTOR: Q IN t It S;,_Al 6i <br /> v � <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> 11 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n obi <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m C? <br /> NORTH(N). N o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m c� �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. 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. `z <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 0 C� <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 a S <br /> NEEDED. 0 <br /> 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o Q <br /> CONDITIONS OF PERMIT: ('(U <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. �1 <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. L - A <br /> 5. h XIS�/lc, gfCroOM Qf Opt, Me j5/t4~ �'" kXcv°er4— <br /> vD `° Bn � a <br /> m cs Irk <br /> 7. o 3 <br /> o <br /> = y : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m' c <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize m m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- C <br /> sue a permit. I further accept all liability which may be a resu a ounty of Burnett relying on this information I am m <br /> providing in this application. I agree to permit county <br /> off <br /> I i i county ordinances or other m <br /> authorized person to have access to the above described pr t e purpose of inspection. -n <br /> Q <br /> SIGN HERE <br /> ( n ure of o o wilding co tor) (date) <br /> ZONING ADMINISTRATOR ' d, <br /> UIV7Y 64 <br /> N CM 0 N NIn0 <br /> ]����Al V1 Gt O U1 (Jt O O <br /> TOWNSHIP PERMITS MAY BETtEC1 WED �y x 0 0 0 0 0 0 <br />