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Burnett County 7410 Co. Rd. K, No. 102, Siren,W154872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N G <br /> C <br /> N <br /> OWNER Ra aM a /e TELEPHONEV/4/ <br /> HOME ADDR SS <br /> �3?i �ocJ 7 h th PPI v o <br /> Sk <br /> / ST(" <br /> -y� i <br /> EMERGENCY/FIRE NUMBER O �/ 7 ROAD NAME Oy�2l///y4 <br /> o l <br /> LEGAL DESCRIPTION(see tax receipt) U O + LOT I DC7 <br /> is <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE 21 ADDITION ❑ PRIVY ❑ �'° <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> y� N <br /> STRUCTURE/ADDITION USE: /✓�'C �� S� <br /> �L-�ZJI- <br /> 1}iome /Cabin; Commercial Business; Bedroom; Deck; etc.) Cn <br /> BUILDING CONTRACTOR: <br /> v <br /> CD <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. O <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) jer/l O m <br /> L TI Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. R m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). rA o <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. ` P <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO Is- O <br /> BUILDINGS,ROADS,LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. p� N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS (R 2. o <br /> MUST BE SIGNED AND DATED BY THE OWNER. o 6 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHENa S <br /> NEEDED. a <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o � <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. p` <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. lVJ <br /> 5. / I✓ n0. m <br /> 6. v E C'n <br /> Z : <br /> 7. oCn m <br /> Cr <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 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize r <br /> m m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- O <br /> 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 <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 ab ve described premisest any reasonable time for the purpose of inspection. mCD <br /> rc <br /> SIGN HERE l - <br /> nat of owner or building actor) (date) Q <br /> ZONING ADMINISTRATOR C^ L • <br /> v+ to fn"to A <br /> Cn N 9 N N P P <br /> 00 Cf N 00 <br /> i TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />