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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator -CD o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. < <br /> r <br /> C <br /> d <br /> OWNER /N ,c L �� TELEPHONE <br /> v <br /> HOME ADDRESS l r? U�� Cn/ LK L/1 /2c��C �yrs •GS-S /S/ (�� <br /> /� ' r C <br /> EMERGENCY/FIRE NUMBER ,5- 3 :5- ROAD NAME Odke X11 0 <br /> LEGAL DESCRIPTION(see tax receipt) <br /> a0J 4. <br /> 1`7— 0 /7c' <br /> r 0 <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE 1:1ADDITION,L�'J PRIW ❑ C) o � <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING NIT ❑ SUBDIVISIFN ❑ n <br /> �iTgz- <br /> STRUCTURE/ADDITION USE: � 0 o <br /> (Home/Cabin;Commercial Business; Bedroom; eck;etc.)a y <br /> BUILDING CONTRACTOR: <br /> •< <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN SY:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> M N -V <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> -n n <br /> n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m :° <br /> NORTH(N). <br /> n <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. o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO I ^ <br /> BUILDINGS,ROADS,LAKE, LOT LINES. D <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I 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. o' o t <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a o, <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <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 ^ II <br /> PERMITTED. 'V <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> Xv0r 00 .0 <br /> m =. m0 m <br /> 6. (Dn N N Q= m <br /> ,'0 <br /> v m m o l 05 3 <br /> 7. ? :: y �� ' <br /> o <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) ID <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m E C <br /> n M <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- Qom, E O <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 N <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 4444`"` m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> m : <br /> 40 <br /> m <br /> SIGN HERE /O� <br /> (sign'atur�eof�owner orbuil n o ctor) (date) <br /> ZONING ADMINISTRATOR \J lm1 <br /> N NUI NN NUI <br /> NOut UIOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> V" <br /> 0 0 0 0 0 0 <br />