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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -D C)- <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> OWNER p TELEPHONE <br /> HOME ADDRESS 7�P as -L O o) -e P1 h 2 <br /> bele 1; r <br /> 0 m <br /> EMERGENCY/FIRE NUMBER 7 a ROAD NAME L B 4 ^e A n f k C I o <br /> LEGAL DESCRIPTION(see tax receipt) S Al*S 4/ a e 73 D O -7 SM u5-s9 (� v, <br /> .J 73 d Q .� W <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE 1:1 ADDITION ❑ PRIVY ur o \ <br /> TYPE OF PERMIT(S): C 0 <br /> ��II / Q <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION EIr—//4e / c <br /> STRUCTURE/ADDITION USE: (j(LC� ��j�� SCI� r <br /> �/ <br /> (Home/Cabin; Commercial Bus <br /> in <br /> /ess; Bed om; De ;ettcc.)/ (� y <br /> BUILDING CONTRACTOR: c ec k �Q r e(/ Space De <br /> (yJ X/c:)--- 'R,' <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETEOR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> XI y <br /> DIRECTIONS FOR PLOT PLAN DRAWING; (AERIAL OR TOP VIEW) 0 o <br /> 11 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). C .� o <br /> in 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO rn �3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF vv Z <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 <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. Ski <br /> o <br /> o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN a °, <br /> NEEDED. o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: ° W <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. l <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLYYS <br /> PERMITTED. r <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 6. _1 I ,� 3aNQ7I1 <br /> G m W 0 o'o ; <br /> 7. DO(- t-b be /yy� � 6-e. 6p-e�L c� OYcI� "1*6 �b Z H :z : `: 1 <br /> ?n In srr = wI ' A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my' c p <br /> knowledge and belief It Is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m o C <br /> " <br /> M i <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is— <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 ��l��i to <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. W: <br /> -n <br /> IY <br /> qq <br /> CD <br /> SIGN HERE _ — O-7 C900� <br /> ( gn l of owner or building cont c r) ' (date) <br /> ZONING ADMINISTRATOR <br /> 1to w <br /> N N V1 N N fT Cn <br /> V1 (!, O (Jf fT O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED�!^ 0 00000 <br /> J `tU � t� <br />