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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -o 0 z <br /> APPLICATION FOR LAND USE PERMITS 315. <br /> r <br /> 5 O <br /> C V\ <br /> OWNER �^ TELEPHONE <br /> HOME ADDRESS �lO <br /> r � <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME � /3 <br /> Goer Sem s% 3yNg Ito uJ <br /> LEGAL DESCRIPTION (see tax receipt) 407 ,L �•r, /�'y •_ f j CD <br /> DWELLING/BUILDING 1:1GARAGE/ACCESSORY ST CTURE ❑ ADDITION PRIVY Cn 8 <br /> TYPE OF PERMIT(S): a ' <br /> � 1 c <br /> / <br /> FILLING/GRADING ❑ CAMPING UNIT 1'�I SUBDIVISION ❑ a <br /> ' N <br /> STRUCTURE/ADDITION USE: lA t a <br /> Home/Cabin; Commercial Business edroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: fi <br /> v <br /> m <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. <br /> �l N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> -nZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m fD <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 n1 <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. T� P <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 �G <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 " <br /> q <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: P 6, <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I <br /> ISSUANCE. I <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 TH EQUIRED WATER <br /> SETBACK AREA. <br /> 5. I'IC17 <br /> II �ti�� C '3 MvCOv <br /> m . m 2i m CL <br /> 6. I I � I I� P m CLQ 3 <br /> 7. �, MAY 2 , 1UUr I o ` y �,ii <br /> Inn <br /> I declare that this application (including any accompanying schedule) has been exart�,¢t�and to the best my c C <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am respond ahs U yracy of Q <br /> all information contained in this application(including any accompanying schedule)and I fur r �r cognize m m : M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in deter i g whether to is- w : C) <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 m <br /> authorized person to have access to the above descripodi5frelpises at any reasonable time for the purpose of inspection. m <br /> CD : <br /> �J m . <br /> SIGN HERE <br /> (signature ofow r`uil ng contract ) (date) y~ <br /> ZONING ADMINISTRATOR411 <br /> ri M fn fn 0 <br /> N to N Mfn <br /> P O (P M O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 <br /> 00000 <br />