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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> OWNER 110111-4— TELEPHONE S9- 3'7/0 <br /> m <br /> HOME ADDRESS <br /> pQ / /1 I `° <br /> EMERGENCY/FIRE NUMBER 69 Dy ,3a./ ROAD NAME 9�h IjYeCRer tom- <br /> Lo4-s 17 I g 9 a° <br /> LEGAL DESCRIPTION(see tax receipt) ,j p/0 /l Cret Ij S <br /> v /YJ o <br /> 11 <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIW ❑ o <br /> TYPE OF PERMIT(S): c 0 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑o/ .d <br /> STRUCTURE/ADDITION USE: G��nC..ow✓lQ l r v- ��j I rAcY1 5 � F (p =• <br /> (COIF" <br /> ..�.�- an <br /> (Home/Cabin; Commercial Business; Bellroom; Deck;etc.) y <br /> BUILDING CONTRACTOR: / /F� S�yLC CbL_ 2.. <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/n X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T - <br /> O in <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p m d <br /> n a <br /> -1111 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> m <br /> NORTH(N). C O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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. z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO c <br /> BUILDINGS, ROADS,LAKE, LOT LINES. <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q 0 <br /> NEEDED. w ` <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> CONDITIONS OF PERMIT: <br /> 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. to <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Q> <br /> 3 NO GR <br /> TDING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY `' oc <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER5. SETBACK AREA. V <br /> ID <br /> Vt lo-/ D I <br /> 6. m Z' 3 �i m a O m� <br /> 0 ,< CL ' t-dim <br /> N C W N o 5 3 <br /> 7. Z H jG 7 43 � , <br /> P : A <br /> =q i mp <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my (,j c i ; p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m' Com' <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ' m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- G' p <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 c"Otwith administering county ordinances or other i m i : -Sa <br /> authorized person to have access to above des ed premises at a)ty-t'eesOnable time for the purpose of inspection. ' N <br /> CD <br /> T : <br /> CID <br /> SIGN HERE Cir 9/Z$�O '^ <br /> (signature of owner r buil ing contracfp� 2� (date) <br /> ZONING ADMINISTRATOR <br /> rr�c <br /> » fA f»f»fp IM <br /> '� -•'l.r+�4,(,,....%�/3', EnTOWNS PERMITS MAY BE REQUIRED 0 0 0 0 0 <br />