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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS I r' l` <br /> aS /McCk11a.,,, $1 a 3 <br /> N <br /> } O TZ <br /> OWNER ��� Sl�JJ/�Gj TELEPHONE 0�5'�9a2{'7 \� <br /> H01'_°-?:DDRESS a 2411� Fp J+AA.) l� R,cc1. < , 4A K le v <br /> r � <br /> 0 <br /> EMERGENCY/FIRE NUMBER jf ROAD NAME <br /> pp <br /> LEGAL DESCRIPTION(see tax receipt) 1 g_ L4 D �� Cj L `O M <br /> o � <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY Cn 0 <br /> TYPE OF PERMIT(S): VVVJJ <br /> 0 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ < <br /> N <br /> STRUCTURE/ADDITION USE: C4k4b-f Nr+io <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: fir <br /> Q <br /> -{ <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n c <br /> a <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(NB)AND INDICATE m m <br /> NORTH(N). fn or <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. <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 /> S. 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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. to o <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Cr ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: p� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n a ^ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY I�.JUQ <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,�E,T,C..,'A,L1L�OyW-E(D WITHIN THE <br /> �REQUIRED <br /> �WATER <br /> / <br /> SACK AREi�tlYr � 1 /W WW U 67 GC O/� <br /> 6. r1, y r.� C .�L�--C. . 1)0- t lL— �,� a a m o- A <br /> N O � � m coi �' � 3 <br /> N O 7'0 <br /> 7. 0b l�&,<id-e—`T <br /> P w <br /> =w: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my L7 C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o. - <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize C" m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m l7 <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 adminis 1 ounty ordinances or other <br /> authorized person to have access to the above described premises at any reasonable urpose of inspection. -n <br /> ®� m <br /> SIGN HERE <br /> (/�M r" m <br /> (signatur caner or building c tractor) Iq at <br /> ZONING ADMINISTRATOR 117 <br /> V to cn cn to fn <br /> N NP NN01NN (T <br /> V <br /> 't/ � Ot VI00 <br /> TVWNSHIP PERMITS MAY BE REQUIRED 2 C 0 0 0 0 0 0 0 <br /> 0000000 <br /> °N14 'uIV <br />