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N t <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> UT 0 O <br /> 1N <br /> OWNER ���L�-s �• S-ro 2 L l f` TELEPHONE ( s-) 63S-46k? <br /> a <br /> p obi <br /> HOME ADDRESS 7 ,S1 ly Pt Ll R&- SPOoNc& i WT S4k0I v <br /> o m <br /> EMERGENCY/FIRE NUMBER 7 S f I ROAD NAME L L <br /> LEGAL DESCRIPTION (see tax receipt) GL / Lg m <br /> 1/ m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ FC <br /> TYPE OF PERMIT(S): <br /> CL <br /> FILLING/GRADING ❑ CAMPING UNITE] SUBDIVISION ❑ ' 1 < <br /> "" i <br /> STRUCTURE/ADDITION USE: �O L— ,J"01°�. / X '"t V , 0 <br /> (Home/Cabin; Co mercial Business; Bedroom; Deck;etc.) m G <br /> m <br /> BUILDING CONTRACTOR: L F <br /> v 3 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. — r <br /> � U C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. (7 a) A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m E <br /> NORTH(N). y � o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m '\ 3 <br /> 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. o <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. C> <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Su N ski <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. o OHO <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN ` <br /> NEEDED. Qj -. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <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. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. a^ <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER V , <br /> SET KAREA. <br /> 5. � l/ C✓L �, lK — t:� ti CLe <br /> X ' oo, r, .0COD It m <br /> o �` m c y " o 3 <br /> 7. / Ld C, <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my L7 c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of u L _ <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m iW <br /> : m <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 m <br /> providing in this application. I agree tA permit county officials charged with administering county ordinances or other 3 <br /> authorized person to.DAve§q-ess to ttfelabove described premises at any reasonable time for the purpose of inspection. -n <br /> CD : <br /> m :V-31SIGN HERE <br /> ao <br /> (signa re owner or build' c S&or) (d te) <br /> ZONING ADMINISTRATOR <br /> N N P <br /> P N Vt O N ut <br /> Oi (n O (n O <br /> WNSHIP PERMITS MAY BE REQUIRED <br />