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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> c <br /> OWNER L L r S U n TELEPHONE�� _ �3S- n <br /> HOME ADDRESS D S / (,VVI C�i1 '//\ YV C� (� S W" ) �0 ✓ v ) <br /> q 0 <br /> EMERGENCY/FIRE NUMBER Sas / ROAD NAME <br /> a 2 csm Vol, & fJ5, 3 / 7 <br /> LEGAL DESCRIPTION (see tax receipt) / L. (u�7 Se ar /Gi 7- `�0�11 /K A/Gt/eY/ � <br /> Gt m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ ur o r <br /> TYPE OF PERMIT(S): 1 v e <br /> FILLING/GRADIN)G ❑ CAMPING <br /> U�NIIT/❑ SUBDIVISION ❑ q N <br /> STRUCTURE/ADDITION USE: LA,W n (Tn hen ^f bl)' i'x}Q— `NJI <br /> (Home/Cabin; Commercial Business; Bed om; Deck;etc.) m <br /> BUILDING CONTRACTOR: <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> �I N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> In Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. t) m s X <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m ;° <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 <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> CD „ m <br /> 6. 0 CL M R <br /> mC1 o � 3 <br /> o <br /> 7. ? Noir ' <br /> o <br /> =o) m <br /> I declare that this application (including a y accompanying schedule) has been examined by me and to the best of my L7 c C <br /> knowledge and belief it is true,correct and complete. I 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 I recognize o o <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 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 <br /> providing in this a plication. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized peE!4tk hav acc s to thqFabove described premises at any reasonable time for the purpose of inspection. T <br /> o : <br /> SIGN HERE 3a o 10 � <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR I M Lba" <br /> (, fn <br /> cn cn cn cn to yr <br /> 731 Ut (n OCnN00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED lq 9g- �H6� 0 0 0 0 0 0 0 <br /> 0 0 0 0 0 0 0 <br /> 3)a8/- 6AR,36E A-pp, <br />