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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator vC) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> rn o <br /> `' y� Q p / r N <br /> OWNER �AY f U £ � -FFy [ )� V TELEPHONE7— <br /> HOME <br /> HOME ADDRESS A01F /v. 511.51, &'L, (I►'),✓ S 5076 v 9 <br /> CD <br /> EMERGENCY/FIRE NUMBER "��J ROAD NAME yd s{�jJ,eE 42(J� <br /> ,TL--J-3 y18133D -(33/554 S 1•T 39/+240 PC`-P& 391Ceo7f). 0a306 I,�j <br /> LEGAL DESCRIPTION(see tax receipt) rG N� LjjV G-614?R6 01 V OF W-000 Lf x- W t/,fit l-or 9 w <br /> (��l m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORYSTRUCTURE i�]1 ADDITION ❑ PRIVY ❑ LG[� o <br /> TYPE OF PERMIT(S): p /0 f• It 1i-K c�� <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a� <br /> STRUCTURE/ADDITION USE: hacA o <br /> n n (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) y <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 17 SHEET OF PAPER. ANY INCOMPLETE OR m <br /> T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. l , <br /> itt y <br /> i��l <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p � <br /> m a <br /> -n z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m 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 /> 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 OQ 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. d Q <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. _� <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 l <br /> �Oc3 3 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN d <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT O <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. ..;�'0 -, -.� t1�j <br /> -0nr C�O � <br /> m �. d � m m <br /> 7. Z : <br /> O <br /> _y: <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of E c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to is- p <br /> J <br /> Information I am <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this informm' <br /> providing in this application. I agree to permit county officials charge fer' rdinances or other �: m <br /> authorized person to have access to the above described premises at an 1no purpose of Inspection. r <br /> ltqCD <br /> SIGN HERE ) ' <br /> (slapature of owns r bbuil�ding/c tractor) ` i (date) <br /> ZONING ADMINISTRATOR / / r v' <br /> N NtnNNfn Vt <br /> I7nr�n�'� Vt V•O V7 V1 O O <br /> TOWNSHIP PERMITS MAY BE REQUARDV�NC o o o o o 0 o <br />