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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 /> N 0 �vAl <br /> ^ a <br /> N <br /> / I, / f p N <br /> OWNER �IGKGte � V�QdCion, e-/TELEPHONE ?15-066CD-Y87Y o <br /> - 0od <br /> HOME ADDRESS qW3 <br /> CD <br /> EMERGENCY/FIRE NUMBER ROADNAME - <br /> �# <br /> LEGAL DESCRIPTION (see tax receipt) R,110 (A) n <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION PRIVY ❑ c <br /> TYPE OF PERMIT(S): ( a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ O <' ��,r� <br /> � � rO <br /> STRUCTURE/ADDITION USE: aOi'✓I � <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: 5a <br /> m <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> T <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. Q <br /> .ZI m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O Q r� <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 <br /> C <br /> NORTH 3. SHOW D M)ENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> r , ` v <br /> 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. ° <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. p <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. m' <br /> o n I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED. <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 t <br /> a <br /> ISSUANCE. t <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. /r _ <br /> CD M. Wm <br /> � n. � Fns x <br /> 6. aB: m <br /> o <br /> 7. o <br /> - cn : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my (1 0 C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize <br /> PP ( 9 Y ) m p <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 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 V <br /> providing in this application. I agree to per R county officials charged with administering county ordinances or other <br /> authorized person to have access to th b de ibed premises at any reasonable time for the purpose of inspection. T <br /> m <br /> m <br /> 69 <br /> SIGN HERE <br /> (sig re of owne wilding contra or) /n/ N (date) <br /> ZONING ADMINISTRATOR <br /> vl <br /> TOWNS IP PERMITS MAY BE REQUIRED <br />