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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator - o o <br /> APPLICATION FOR LAND USE PERMITS 3. jTy 1 n <br /> V O v <br /> N <br /> OWNER �(l / TELEPHONE 0 <br /> CD O <br /> HOME ADDRESS F <br /> r � <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> J0 j � 9 <br /> �n`rZGSvvt l> /-7 10 Dov, !ca 3 L p 1 = Sr <br /> LEGAL DESCRIPTION(see tax receipt) 5�� �' � /� <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ O <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <: ` <br /> STRUCTURE/ADDITION USE: M I <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) (n <br /> l _ y <br /> BUILDING CONTRACTOR: h tS�t�1f i <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/]X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) OT o <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C) <br /> NORTH <br /> 3. SHOW D M)ENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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. vl ° <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. is <br /> 6. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. IN <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. � 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o n <br /> CONDITIONS OF PERMIT: XJ <br /> 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ~ o- <br /> ISSUANCE. I _ 91) <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. �` <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY `w <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> 3L— <br /> SETBACK AREA. <br /> 5. 103 MG d <br /> f m <br /> CDvW� 0vQvv <br /> � . l / f OLD. 2 Dam � <br /> 6. Q' 1 w� F� l�I m. 0 m �c <br /> N N Q N <br /> 7. O ' T <br /> - m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C) c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of CL <br /> 0 <br /> all information contained in this application(including an accompanyingschedule and 1 further declare that I recognize <br /> PP C 9 Y ) � (D � O <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> 0 : <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 <br /> authorized person to have access to the abovj oescribed p emises at any reasonable time for the purpose of inspection. T m <br /> m <br /> SIGN HERE614 <br /> (signatuwneror ilding cont ftor) (da I') <br /> ZONING ADMINISTRATOR _ <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> I lT <br />