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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> o <br /> N <br /> �? 1 C <br /> OWNER -Y' �G TELEPHONE 71S _ 6 _ Pe/d,� o <br /> a <br /> m <br /> HOME ADDRESS o wt�->' — SSI 3 v 9 <br /> 9 <br /> EMERGENCY/FIRE NUMBER — ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) s' 2 3 T y O2 !7 0/ Zrn <br /> n <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE I� ADDITION ❑ PRIVY ❑ m C <br /> TYPE OF PERMIT(S): ocr <br /> ' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5 <br /> N <br /> STRUCTURE/ADDITION USE: ST O'-ct,ot31da:l 0 <br /> (Ho a/Cabin; Com rcial Business; Bedroom; Deck;etc.) m <br /> m <br /> BUILDING CONTRACTOR: S e, L � ar <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8Ya X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3. <br /> R <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> x N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. a o0i ' Z� <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 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 <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 /> O 9 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: c <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT t `" <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 /> 6. �O � 3n` r CL <br /> Z N N Q <br /> 7. O <br /> Cn M <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my L3 c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of �+ C <br /> n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CD 'm E m <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 m' <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ; m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> CD <br /> m : <br /> SIGN HEREi..t� <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR �Ttm r b611� I <br /> e+�A 19�A 40 40� <br /> N N V1 <br /> N N O o <br /> mN mO oO O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 0000000 <br />