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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 'o 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> c � <br /> CL 0<3 <br /> OWNER L /( U�t. / U/� 4�j <br /> (//n/ ��/_a.y1,y o <br /> HOME ADDRESS / cl'n 1�+A /L ODS/✓ �–/Y^/Q — /�GLI) �/GLy v <br /> EMERGENCY/FIRE NUMBER /���0 ROAD NAME �D�N� L+Nt! .. <br /> 471 <br /> LEGAL DESCRIPTION(see tax receipt) A( G GS Ac EA O 72241 R 194y <br /> y <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ C�'4 C <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING ❑ CAMPING UNIT SUBDIVISION ❑ L3' <br /> N <br /> STRUCTURE/ADDITION USE: �D IL off d L Q�& ��� &Wd- o <br /> _ <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) m <br /> BUILDING CONTRACTOR: lit <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> m 3, <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> x N ^ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) Oo ) <br /> T Z e <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m jp <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Do <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO O <br /> BUILDINGS,ROADS,LAKE, LOT LINES. / <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N W <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. o <br /> _o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN fCr <br /> ° c c` \ <br /> NEEDED. 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o ` ) <br /> CONDITIONS OF PERMIT: O <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERM(T. i <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHOREljlrjt <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY i� <br /> PERMITTED. ( <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE RET ED WjV§ <br /> SETBACK AREA. <br /> 3 CL <br /> COL. M <br /> /VI <br /> 5. J <br /> 7. NG o ' z <br /> =�: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Cr ID <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of ne. C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize �j [ CD E M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <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 admin stering county ordinances or other m <br /> authorized person to have access to the above described premises at any reas time the purpose of inspection. <br /> SIGN HERE <br /> (signature of owner r building contract date) <br /> ZONING ADMINISTRATOR in <br /> N NNNNU101 <br /> V7 utONOOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 o <br /> 0000000 <br />