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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator M o o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> c7� N <br /> OWNER TELEPHONE6 f4• / 75:p Icr, <br /> HOME ADDRESS/ 6nn' 01 �/"/uS 7l� yeo <br /> L� m <br /> EMERGENCY/FIRE NUMBER c+wq� <br /> �5�57 ROAD NAME <br /> P <br /> LEGAL DESCRIPTION(see tax receipt) 3,;Z-9Yd S– D 3 -700 <br /> DWELLING/BUILDING (S—GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ (n <br /> TYPE OF PERMIT(S): FILLING/GRADINGt9- CAMPING UNIT 11 SUBDIVISION ❑ nO <br /> /)747 u✓r C <br /> STRUCTURE/ADDITION USE:h ( 9MOiJNiI07�,dYt! JrWe4, f-,A-tnX '/SY'O/ `�7-e/Ao�, <br /> (Home/Cabin; Commercial Business; Bedro m; Deck; etc.) U) <br /> BUILDING CONTRACTOR: /eol�/'e 60 6j, (/ea11/6 <br /> G' <br /> CD" <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR A— <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> ;a NJ <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. 0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE mCD <br /> NORTH(N). (n o <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 W <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. / _ ,f ,o 0 <br /> ee <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 C <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. J <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. � <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY (y <br /> PERMITTED. V <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA <br /> —S-g6 is/ / w�, ,liC(f- <br /> 5. v" / (t� L/'/ I��CJ � M M. 0 CDD f m(tel <br /> 6 .3 o. m 0,-' `D ,'0 <br /> CD C: �3 <br /> 7. o �10Dt'� m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G7 c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of a cc <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize <br /> PP (� 9 Y ) p � <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 d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to ess to the above described premises at any reasonable time for the purpose of inspection. m ° i Ido <br /> m r <br /> SIGN HER C <br /> (signature of owner or ilding contractor) (date) <br /> ZONING ADMINISTRATOR ' "' ' ' ' '5 <br /> TOWNSH PERMITS MAY BE REQUIRED <br />