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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 � ' ^Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> y <br /> C <br /> el <br /> OWNER TELEPHONE 15 (oS� -333 <br /> HOME ADDRESS d e C� � v ��0 <br /> 0 <br /> EMERGENCY/FIRE NUMBER �' G� ( ROAD NAME p e� �� , U, <br /> LEGAL DESCRIPTION(see tax receipt)34 ,V N ) 5P5E S k I ikiculvy, <br /> o� <br /> DWELLING/BUILDING 91 GARAGE/ACCESSORY STRUCTURE Er ADDITION PRIVY ❑ CO � <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ CI <br /> STRUCTURE/ADDITION USE: i C�. �� Wo � (� <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) m 7 j \ <br /> BUILDING CONTRACTOR: n e ll� fS v <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 _ <br /> XI 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. m 'Zo <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <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 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 <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. U2o <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> 0 <br /> CONDITIONS OF PERMIT: <br /> I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Q <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 IlN1 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. y <br /> M =- a) = ((11 1 G <br /> 6. 8 � 3n Ow 94 x <br /> (D Cs <br /> a 0 9 3 <br /> Z : N o _1 <br /> O <br /> m <br /> .tare that this application (including any accompanying schedule) has been examined by me and to the best of my \: c p <br /> +dge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of :31 o c <br /> ration contained in this application(including any accompanying schedule)and I further declare that I recognize : : m <br /> Formation I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to is- <br /> I further accept all liability which may be a result of the County of Burnett relying on this information I am <br /> 's application. I agree to permit county officials charged with administering county ordinances or other m <br /> to have access to the above described premises at any reasonable time for the purpose of inspection. T <br /> m : <br /> m <br /> (si 'afore o r or building contr ctorr))� —r '(date) <br /> 44 40 f� <br /> N N (nNN010i <br /> N VtONOl00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />