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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v G) z <br /> APPLICATION FOR LAND USE PERMITS 3 < ° <br /> r <br /> / y o <br /> N <br /> C <br /> OWNER �tkn h61ey-- TELEPHONE <br /> HOME ADDRESS 6 985 -i�e,t Lk <br /> / e _ /r)T O <br /> p� <br /> 0 CD <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) / �--.� C'S� V r1 p/n / <br /> Cn <br /> TYPE OF PERMIT(S): <br /> DWELLING/BUILDING ElGARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIW ❑ rn o <br /> ` � � <br /> FILLING/GRADINGGEl CAMPING UNIT ❑ SUBDIVISIONS Cj n <br /> STRUCTURE/ADDITION USE: C S Z2y) V /�z <br /> o <br /> _ (Home/Cabin, Commercial Business; Bedroom; Deck;etc.) <br /> 0 �J �, ,— ' <br /> BUILDING CONTRACTOR: � 6-. 74- /a <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m _ <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING• (AERIAL OR TOP VIEW) 0 <br /> On EL <br /> m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T C Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m z <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 \ <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. c <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO TT <br /> BUILDINGS, ROADS, LAKE, LOT LINES. Q�v <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0 �V <br /> MUST BE SIGNED AND DATED BY THE OWNER. c .L <br /> I 0 ) <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN W <br /> NEEDED. AN <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z b <br /> CONDITIONS OF PERMIT: p L11 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT p; O <br /> ISSUANCE. /u <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. l <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. d <br /> 5. <br /> 6. memo� ov <br /> 3 ' m <br /> 0ED C <br /> 7. <br /> Z : N ��< : i -I <br /> I declare that this application includin an accom an in schedule has been examined by me and to the cn <br /> best of my I,; C m <br /> PP (i 9 Y P Y 9 ) W <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of m C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CL <br /> m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in dep <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying teto rmining whether to ze this information I am <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> R , <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. �: <br /> m <br /> CD <br /> SIGN HERE d+ <br /> (signature of ner or building con tor) (date) <br /> ZONING ADMINISTRATOR , <br /> NwfncnriK) 0(' <br /> N N U I N N U 1 U 1 <br /> V7 Vt O Ut 07 O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />