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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 /> N ° <br /> Sol- G63' 7a7(e/ n <br /> OWNER , Id f � TELEPHONE 713 _3�r7 -aSay k0- <br /> HOME <br /> onaL a. uec. sly ADDRESS 379 `/Sr5,7 i J il/Or}�,+�e I��Xn <br /> 0 <br /> W <br /> EMERGENCY/FIRE NUMBERSOSO ROAD NAME 1.�kf:v;4! W/ AL, <br /> Lo�S !p, 11, la , anc). 13, blocK b, 4 MOLLT Scc" , e <br /> LEGAL DESCRIPTION(see tax receipt) Clanx I.&I<e PaAa(rF Go 1ot-3 so, -Tc( 'f 3 /tJPj6W <br /> m <br /> o <br /> DWELLING/BUILDING ® GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ <br /> Q <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ N. <br /> ° <br /> STRUCTURE/ADAOfl�t <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) U)� <br /> BUILDING CONTRACTOR: 7e-U <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O ~ <br /> A m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n o <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m v <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C �a <br /> NORTH(N). m <br /> oC� <br /> TO ALL LOT LINES,( BUILDINGIS)TO <br /> 3 CEN ERLINE OFF ROAD,(C)BUILD NG(S)MEASUREMENT TO HESHOW DENSIONS IN FEET OF THE FOLLOWING: (A) (ORDI ORDINARY HIGH WATERMARK(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 C <br /> BUILDINGS, ROADS,LAKE, LOT LINES. <br /> S. 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 Q ?, o O; <br /> MUST BE SIGNED AND DATED BY THE OWNER. o, <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN " ° <br /> NEEDED. <br /> Z O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: <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. Vtl <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY I <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. //�`Y /� Q / <br /> 5. jp- ` 7L— / 9 � v0onov <br /> (D 3 <br /> 6. ^ y y N l0 <br /> Z : O <br /> O T m <br /> 7. = rn: <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m 5 m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize (D 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 <br /> v : <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. - <br /> m <br /> SIGN HERE <br /> Ia - 31 - oi c`�1 <br /> (date) Jl J <br /> (signature of o ner r building contractor) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED ¢ <br />