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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 0 O <br /> r C <br /> O ® / Cf d <br /> OWNER �4kG f S� J�N� �Ct�C�Cr'�`J J TELEPHONE b/2. / �/Z1� <br /> ,/�� r <br /> HOME ADDRESS 5-7Y0 Wf sy,yuR� �`� �l 7-/44 ��4,/t ✓ ,/Sy/D r <br /> T D <br /> EMERGENCY/FIRE NUMBER Z ROAD NAME <br /> 1 <br /> 01 <br /> LEGAL DESCRIPTION(see tax receipt pT 3 Oc lyV /p��s ,�GC30 <br /> e <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION PRIVY c o "� <br /> TYPE OF IT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> / <br /> S. <br /> UCTURE/ADDITION USE: e7Me <br /> ome/Cabin; Commercial Business; Bedroom; Deck;etc.) m 'W <br /> UILDING CONTRACTOR: L �' <br /> y` w.vr/f r U /V ot" e <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR �w-,v OF -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 4cje.I�Di✓ m <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n cL <br /> ?i O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m c <br /> NORTH(N). 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 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. Q <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 5. 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. ° <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q o. <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o Oi <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ` <br /> ISSUANCE. O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. I n <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY `I�l <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. ply- r y <br /> 5. bill � �SSI (� / - V. MMW two ri m <br /> 6. a m cmm <br /> v x <br /> m o 3 <br /> N O O 10 <br /> Z Nm� <br /> 7. c m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 47 p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o. <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m 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 to permit county officials charged with administering county ordinances or other m <br /> authorized person to Ilave access to thq abpve described premises at any reasonable time for the purpose of inspection. T <br /> m : <br /> m : <br /> SIGN HERE ==41114= <br /> 7— <br /> (signature f o netr or building contra to (date) <br /> ZONING ADMINISTRATOR <br /> cnno ! o <br /> 0000000 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0000000 <br />