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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 3• <br /> r <br /> N <br /> UI <br /> C <br /> t] C Its <br /> OWNER D�7LL ,� , /A�j-�� I,(�j9L 7C1 —.5 TELEPHONE�6��I <br /> m <br /> HOMEADDRESS / �7y0 ?j- �iy�— /¢(/ �Q i�1N111� ��� ✓--� r r 9 <br /> EMERGENCY/FIRE NUMBER Z Z ROAD NAME <br /> A-&PZ R colW4-0O <br /> LEGAL DESCRIPTION (see tax receipt) d <br /> � �O07 / /Q nt2l �• <br /> DWELLING/BUILDINGG ❑ GARAGE/ACCESSORY STRUCTURE V ADDITION 11 PRIVY <br /> ❑ <br /> v <br /> TYPE OF PERMIT(S): CL <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5• <br /> STRUCTURE/ADDITION USE: /-Zrn V I (1) <br /> /� <br /> (Home/Cabi <br /> n;Commercial Business, Bedroom, Deck,etc.) a,2. <br /> �J <br /> BUILDING CONTRACTOR: L/9L4E <br /> R <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/1 X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. ;a N IN <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING; (AERIAL OR TOP VIEW) '()/�(M I� L I,Lw - T ° Z <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 C c <br /> NORTH(N). rn <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 'a <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF o <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 /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ? 1 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS M o <br /> MUST BE SIGNED AND DATED BY THE OWNER. o 9 0 <br /> 0 SO <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN g <br /> NEEDED. VI <br /> Z d <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 /> 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 /> SETBACK AREA. <br /> 5. ;a -0 w d IOD m <br /> CLI CL <br /> 6. 9 N N O y o'Co <br /> i <br /> Z : , <br /> 7. : <br /> = rn: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o E <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 11: <br /> m A <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 U E 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 described premises at any reasonable time for the purpose of inspection. <br /> (D : <br /> 40 <br /> SIGN HEREFol (date) <br /> 41111 <br /> gnat'ure�of,owner or building contractor) U <br /> 40 <br /> ZONING ADMINISTRATOR '^ N m"T) 40 4A 4Wd M <br /> P O ,"cn 00 <br /> 0000000 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />