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Burnett County 7410 Co. Rd. K, No. 102, Siren, W154872 Office of Zoning Administrator 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 ` <br /> r l0 <br /> uN O <br /> Cn <br /> CD <br /> C ` <br /> OWNERL (r 1/C 4 esceI� TELEPHONE l5� 5152 — Y,?O� v vN.t <br /> O m <br /> 38/9 /J <br /> HOME ADDRESS cr�iYJAR/� 1�l/r' oAt✓ /?9n/ Ss�23 f <br /> P <br /> EMERGENCY/FIRE NUMBER o'- p '7' ,3 4 ROAD NAME P7,r,r&1,t) <br /> / en P— <br /> Al'n /qR r'AV IZL7. <br /> LEGAL DESCRIPTION(see tax receipt) L�� r (1l�yL/ � /�� � /� (n (� <br /> DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ G Cl) °• <br /> TYPE OF PERMIT(S): Q a <br /> FILLING/GRADING ❑ CAMPING UNIT SUBDIVISION El /' <br /> 3� uJ [T/ y <br /> STRUCTURE/ADDITION USE: 0 � <br /> A , / Wom /Cabin; Commercial Business; Bedroom; Deck; etc.) co <br /> BUILDING CONTRACTOR: -7iuiff , <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81AX 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> ;a N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> TZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE rn <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO rn 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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. t <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. �j`•- F C <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIF C TIO WEN O <br /> NEEDED. q,� r „ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. O i 11ys ►1 o WQ <br /> CONDITIONS OF PERMIT: � iW <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS <br /> ISSUANCE. l!l <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY p <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER �1 <br /> SETBACK AREA. <br /> 5. rte' "] <br /> re — m W 0 CD n f m <br /> N .1aZi <br /> : <br /> 7. m <br /> - (n : A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) 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 recognize ` <br /> : : m O <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- G) <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 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> CD <br /> SIGN HERE <br /> (signature W!{ ctor)_ /B (dat <br /> e <br /> ZONING ADMINISTRATOR <br /> d �> <br /> OWNSHIP PERMITS MAY BE REQUIRED C <br />