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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 /> c <br /> CD <br /> OWNER SF�EP40\) /���iY�`�/I�JF Fy`A��' TELEPHONE gJL_'"�'•7->LJJ�o <br /> HOME ADDRESS 7'l p <br /> D i' l L L l ` c7 �q/ V uA cp <br /> EMERGENCY/FIRE NUMBER &-2-) / ROAD NAME LILLY N E <br /> (�1 iSS Z-{& E !z_ ` <br /> LE AL DESCRIPTION(see tax receipt) Lor— C� �� M `/ 1 P Z-4 E (--5 W Sr] <br /> DWELLING/BUILDING ElGARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ ( <br /> TYPE OF PERMIT(S): r <br /> FILLING/GRADING ❑ CAMPING <br /> UNUNITE] 'SUBDIVISIONT. <br /> ❑` (A< <br /> STRUCTURE/ADDITION USE: �7�2�TCy �' (J— 10 <br /> f (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) m ' 2 <br /> BUILDING CONTRACTOR: � L` L,Iw JCA EID av V) <br /> v <br /> CD <br /> 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. <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> n CL C <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m a <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C o <br /> NORTH(N). Ch <br /> 3. SHOW DIMENSIONS 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 9J (r Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 1 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. W <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 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. ° <br /> � rn <br /> o � w <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Ct ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o a <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 0 Q/ d <br /> PERMITTED. I/ <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> This structure to be used as private residential m � d d o m <br /> 6. garage/storage only. Not to be used for human M � n W o F. 3 <br /> NO O 0 <br /> habitation. Z � y `°'2 ' <br /> 7. : U) i m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G)I C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of a E <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 ri ed with administering county ordinances or other m <br /> authorized pers o have access to the above describe onable time for the purpose of inspection. T <br /> i m <br /> ar <br /> SIGN HEREIP <br /> (signature of of r or buildlh ntr (date) (� <br /> ZONING AD ISTRATOR �f �)c! <br /> h Mp " �»tncnwcnfn <br /> rl(' ✓,, I��O cNn cNnocNn �oo <br /> v r <br /> TOWNSHIP PERMITS M 0 0 0 0 0 0 0 <br /> t 1 <br />