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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator -0 O Z <br /> APPLICATION FOR LAND USE PERMITS CD_ <br /> r <br /> I N O <br /> N <br /> OWNER JQMeS 1prlCe TELEPHONE 7/S -`fas-r�6a7 <br /> o <br /> Q m <br /> HOME ADDRESS 16 �, �J / ✓P{� �/ (/� t/P/" �4 ��5/ G{/I s�Qaa O <br /> r � <br /> EMERGENCY/FIRE NUMBER �p S/rj' (OQ�,aha /WSP, ROAD NAME I ydE+{7 /,K. 00W, o <br /> Cott , C5fn/ V. 5/ 0o. /4 Pa,-Edi 4at, 3, C5fn, <br /> LEGAL DESCRIPTION (see tax receipt) GOVT LOfs y YS, Sec I{o� M <br /> M <br /> - <br /> DWELLING/BUILDING 9GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ® PRIVY ❑ rn 0 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> a <br /> STRUCTURE/ADDITION USE: a-ell S' <br /> (Home/Cabin; Commercial Business, Bedroom; Deck; etc.) rn <br /> BUILDING CONTRACTOR: ��✓ s^s `OAI5 r. Dan Pro--f f,-t '- <br /> d <br /> .D <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/]X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> � N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O `m <br /> n a <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n �o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m -Z? <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 Z <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 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> O � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN o <br /> NEEDED. ' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: < C p <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. r <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELIN£�/�� Gy <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 /> v (7r DD � 'D <br /> 6. m 3 n m a m <br /> 7. Z . yoo . io <br /> o -n 2 m <br /> — m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Oc C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m c m <br /> all information contained In this application(including any accompanying schedule)and I further declare that I recognize M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 county officials charged with administering county ordinances or other ,o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. fD <br /> T <br /> (D <br /> N <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) <br /> ZONIN ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />