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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o-�p o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> nd <br /> OWNER TELEPHONE 71 V 88_��3 � 0 r <br /> ' 6 m <br /> m <br /> HOME ADDRESS a G G1 <br /> O <br /> (tom r m <br /> o <br /> EMERGENCY/FIRE NUMBER \ ROAD NAME Z:' 1 I i <br /> LEGAL DESCRIPTION see tax recei t Cj, IS <br /> Ce <br /> DWELLING/BUILDING © GARAGE/ACCESSORY STRUCTURE 1:1ADDITION ElPRIVY ❑ ur <br /> TYPE OF PERMIT(S): 5 r <br /> FILLING/GRADING ❑ CAMPING UNIT ElSUBDIVISION ❑ <br /> wtdSTRUCTURE/ADDITION USE: t�w,rL �'-/ X S© W/ a.thli � <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) u1 <br /> BUILDING CONTRACTOR: a, L <br /> M <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> �I N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIE" 0 a <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). <br /> n <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 <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 I <br /> BUILDINGS,ROADS,LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. o <br /> I <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 1 0 L <br /> MUST BE SIGNED AND DATED BY THE OWNER. m o <br /> o � <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN Cr <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT SCJ <br /> ISSUANCE. Q 1 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <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 /> ;ov0 dm � 0 -0 <br /> � m <br /> 6. �. mK ,n 'Ls3 <br /> Z <br /> 7. G <br /> = m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c p <br /> knowledge and belief it is true, correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of ��nrCLC <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize Xl M <br /> M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ♦ E E 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 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. m <br /> m : <br /> M <br /> SIGN HERE <br /> may- 9� <br /> (signature of ow or build g c r o (date) <br /> ZONING ADMINISTRATOR <br /> w to En to to to <br /> N N Ut N N fT N <br /> V1 utON (TOO <br /> TOW SHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />