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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Adminis - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> OWNER /C/7A/Ly //0 7&Yl or% -- TELEPHONE 6 el'7- 9 6,9e �O <br /> HOME ADDRESS ,41V [3U 6n01 /7' f?�t J /� A�4L � /0 v 3 <br /> o � <br /> EMERGENCY/FIRE NUMBER 31005-& ROAD NAME <br /> ry, I / / r� <br /> LEGAL DESCRIPTION(see tax receipt) ,�() — 3 (o ''USS L �//V /� �� � A V <br /> r+�y0 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE I� ADDITION El PRIVY ❑ C') <br /> TYPE OF PERMIT(S): CL <br /> c <br /> FILLING/GRADING ❑�CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: (_'f A!L-Ka:ir ep <br /> g �+�/(HHo�me/C in; Commercial Business; Bedroom; Deck;etc.) rn <br /> BUILDING CONTRACTOR: /V L!L/ fY�.�J rtJ,� 8Z.0-5 -gag' i fir <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0ea <br /> -n O Z <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 /> NORTH(N). Cn 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO rn <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. 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. A <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. 'e W <br /> o '1J <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN Cr r <br /> NEEDED. -Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o O <br /> CONDITIONS OF PERMIT: Q <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT • t <br /> ISSUANCE. Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. -� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 1 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER �. <br /> SETBACK AREA. <br /> 5. jC) r0 O � <br /> This structure to be used as private residential A CDR d r, „ m <br /> 6. garage/storage only. Not to be used for human a y . <br /> a : g C g . o 3 <br /> habitation. o N m =i <br /> 7. ern : i m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c ID <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of o 0 <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognizem m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- d ' O <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. -n <br /> m : <br /> CD <br /> SIGN HERE <br /> (signature of ow building contractor) (date) <br /> ZONING ADMINISTRATOR ` �+ <br /> N tj M N r)01M <br /> IT (lO Ui Ut O O <br /> TOWNS IP PERMITS MAY BE REQUIRED <br /> °00000 <br />