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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 /> 0 <br /> tl! » <br /> CD <br /> OWNER �0'224 ^/ �� TELEPHONE <br /> d <br /> HOME ADDRESS ;2f0 <br /> / O p cl — Ib <br /> CD <br /> EMERGENCY/FIRE NUMBER � £ ROAD NAME 3� <br /> LEGAL DESCRIPTION (see tax receipt) 0?3—<k/6 I <br /> I r0i <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTUREADDITION ❑ PRIVY ❑ 'V� cn 0 <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SU DIVISION ❑ L m <br /> STRUCTURE/ADDITION USE: � /-4Lt S- K4 IN4 � <br /> (Home/ in; Commercial Busine Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: -:;t 4 ZCD <br /> s9 <br /> C _ <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. 0 <br /> O <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. a W <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m �? <br /> NORTH(N). W 101 <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. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO r0 <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 ) <br /> MUST BE SIGNED AND DATED BY THE OWNER. 5 0 t <br /> o i -2� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q S <br /> NEEDED. 0 Cj <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 0 1 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT pp 1 <br /> ISSUANCE. AI <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. <br /> CD - W CD L m <br /> 3 nm 'c c •'O <br /> 6' v m fn <br /> N C Y1 3 <br /> 7. C fA =ij'� <br /> Cn : <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my i7 c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m 3 m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- l7 <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have acc ss to the abov escribed premises at any reasonable time for the purpose of inspection. <br /> m <br /> CD <br /> SIGN HERE p <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR 1G1 <br /> Fn Fn'm En to to <br /> N Nf71 NNu7 V7 <br /> U1 U1 O N UI 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED o <br />