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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -V 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N O <br /> c <br /> OWNER / /�y� TELEPHONE <br /> V <br /> HOME ADDRESS / �Q / O <br /> /.�� ►L a 1/4'�G ia-sc� �o ��ti//Yl d '.�A toy .5--��� 9 <br /> ��— rt*c:,. <br /> m <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> f?1 1 <br /> LEGAL DESCRIPTION(see tax receipt) ��(� lux i� � <br /> DWELLING/BUILDING , GARAGE/ACCESSORY STRUCTURE 7 O <br /> TYPE OF PERMIT(S): ❑ ADDITION ❑ PRIVY ❑ <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ `��\("'\III 5 <br /> �� ``!/�2 } N <br /> STRUCTURE/ADDITION USE: l <br /> _ T��CTle- s Q x y�! <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) rn S <br /> BUILDING CONTRACTOR: E_ e''41r�1.S�( - ,gin.e,�..�y�tt/ <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n p <br /> O — (� <br /> m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> n <br /> 'rl d -` <br /> In Z <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 <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m II 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF JV <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 O� <br /> BUILDINGS,ROADS,LAKE, LOT LINES. Q <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS X) <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> v 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHENq S, <br /> NEEDED. - <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Ci <br /> ISSUANCE. 0 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 'nCl I o� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 1V qJ <br /> PERMITTED. t/+ �OI <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> VSETBACK AREA. /^ <br /> 5. /1N/ S-13-9C] <br /> m <br /> / <br /> �" <br /> 6. p 3n rsc' c .� <br /> nI C N y 0 <br /> 7. Z : y COD c �fO q <br /> O <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my O <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy ofm C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize �m 2J <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 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 w' <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other E m '• <br /> authorized person to have access to the abo a described premises at any reasonable time for the purpose of inspection. m <br /> m : <br /> ,e. m <br /> SIGN HERE <br /> (slg n e of owner o uii g contractor) (date) �e <br /> ZONING ADMINISTRATOR (/�� <br /> wfnfnu+wwM <br /> N NU� NNN (T <br /> Ut V\ O VINOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED0 0 0 0 0 0 0 <br />