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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 0 o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> }., <br /> rn <br /> r N <br /> OWNER TArn es' /1 C C f� TELEPHONE 7/S_ �S �P — <br /> /� <br /> O� <br /> HOME ADDRESS A S7-7 X uasow,9AJ D,— <br /> r � <br /> ,���s�//� �✓j� w <br /> EMERGENCY/FIRE NUMBER �S?� ROAD NAME pj _ <br /> CSC <br /> LEGAL DESCRIPTION (see tax receipt) S a� 7 � � /$4d <br /> 7 � � <br /> Q <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION PRIVY ❑ c <br /> TYPE OF PERMIT(S): 5 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> ,/// m <br /> STRUCTURE/ADDITION USE: <br /> HO YY! C a <br /> (Home/Cabin;Commercial Business; Bedroom;Deck,etc.) <br /> / (� <br /> BUILDING CONTRACTOR: NO2TA/A+-j+O -- �� <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 C <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n a <br /> '—t o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NBm)AND INDICATE m c <br /> NORTH(N). y <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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. P <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO Q <br /> BUILDINGS,ROADS,LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. oSO <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS 2 0 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN V g <br /> NEEDED. <br /> Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. P <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> Pj)1 <br /> ISSUANCE. <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 /> SET ACK AREA. <br /> 5. p - or.- a n M <br /> � a <br /> � •� a n 'rF�= 7g <br /> 6. <br /> N " 0 ,0 -I <br /> Oitl <br /> 7. =o' : [ m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 2 C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ' C ; , <br /> all Information contained in this application(including any accompanying schedule)and 1 further declare that I recognize L7. mm <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- d <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 n <br /> Y <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> - <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> m : <br /> SIGN HERE o/� <br /> (signature o w r or b in r) (date) <br /> ZONING ADMINISTRATOR '^'9 <br /> q N NNNN V7 U7 <br /> O 0 0 0 0 0 0 <br /> T WNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />