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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 0 C) <br /> APPLICATION FOR LAND US1E� PERMITS 3 <br /> iT/l / G r <br /> OWNER ELEPHONE Z 1 J COS ( 3 I Z— o' o <br /> W I LL I w,,,,. �v..�� Dc�e t,' if % a of, <br /> HOME ADDRESS (0 4 y ( �t " � �/-yv�-L_ QAt~J�uM� y 'g�® 0 <br /> / r m <br /> EMERGENCY/FIRE NUMBER W y 4 ' ROAD NAME Lt Ll <br /> D .� l A r..--� o_ <br /> n <br /> LEGAL DESCRIPTION(see tax receipt) / / ley <br /> � <br /> y v CK o <br /> DWELLING/BUILDING 11GARAGE/ACCESSORY STRUCTURE L7 ADDITION ❑ PRIVY ❑ CD <br /> TYPE OF PERMIT(S): cQ <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISIONS. <br /> 5 <br /> STRUCTURE/ADDITION USE: 0 Vt1-q— l.x 5-Q— E <br /> �}�. o <br /> _ <br /> (Home/Cabin; Commercial Business; Bedroom; eck;etc.) <br /> BUILDING CONTRACTOR: vq'-`�S <br /> N1 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> CD <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> 0 R <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 c <br /> n n <br /> TZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 0) z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m it,CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. (�4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO �)BUILDINGS, ROADS,LAKE, LOT LINES. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. t�� ` <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS ( SU <br /> MUST BE SIGNED AND DATED BY THE OWNER. 5 c <br /> o -� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN W o <br /> NEEDED. T <br /> 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW, o p <br /> CONDITIONS OF PERMIT: <br /> 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 VJ <br /> PERMITTED. d <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> This structure to be used as private residential A v 0 r o o v <br /> CD M <br /> 6. garage/storage only. Not to be used for human 3 a _ <br /> O M N H O <br /> habitation. Z y 0 o _t0 =i <br /> 7. o X11` s ;u <br /> = q ' a; m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ID <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of i moi C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize o: 0- - <br /> CD <br /> i p: <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 1� p <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 o <br /> authorized person to hav cess to the pbtWe des544d premises at any reasonable time for the purpose of inspection. T 9 <br /> t 9 <br /> SIGN HERE <br /> (signatu �owneoringcontract ) (date) <br /> tx <br /> ZONING ADMINISTRATOR i <br /> v+v+to to w <br /> N V7 N N N <br /> TOWNSHIP PERMITS MAY BE RE 0 0 0 0 0 <br />