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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator/r /- z <br /> oo <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N <br /> OWNER TELEPHONE <br /> HOME ADDRESSCD <br /> Com— r m <br /> EMERGENCY/FIRE NUMBER [ �/7(o ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) (�p `!D R• /j�O rN 0-941 //r JfL JSP .� <br /> o 10/4 -je9, n 3 h d6 CD <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ rn 8' <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING 0 CAMPING UNIT ❑ SUBDIVISION ❑ � �' <br /> STRUCTURE/ADDITION USE: h(�A��_{,J � � S' <br /> J (HomelCabin; Commercial usiness; Bedroom; Deck;etc.) rn 1/� <br /> BUILDING CONTRACTOR SSS <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> M N C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 41, <br /> n <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n �-t� <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 'S =A <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <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. o <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o `4J <br /> 0 I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN T o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT l <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. U 1 <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. <br /> m � dr0 ( f° am <br /> 6. 3EL2 D .D <br /> 'O N C N N O_ <br /> 7. Z y N O t0 <br /> O XI <br /> = � m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G7 c C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- MO <br /> 0 : <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m + <br /> (D <br /> m •Ga <br /> SIGN HERE <br /> S - 4a2 <br /> isiqniLuredrowneror building contractor) (date) <br /> �j <br /> ZONING ADMINISTRATOR <br /> O i <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />