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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Adminr -CD o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> f g3yg4e1j, PL PK�y. <br /> OWNER /�d//� W144,i�-o/ EL7 <br /> HOME ADDRESS f ��� 7`70 <br /> �J Oo m <br /> EMERGENCY/FIRE NUMBER I ao$' ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) �, �OV 3 <br /> 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING ElGARAGE/ACCESSORY STRUCTURE ADDITION ElPRIVY ❑ C/ o <br /> v <br /> FILLING/GRADING El CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> //��77 5. <br /> STRUCTURE/ADDITION USE: /T&L� 0 <br /> (Rome/Cabin; Commercial Bu mess; Bedroom; Deck;etc.) y <br /> BUILDING CONTRACTOR: /z 5 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'h X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T� — <br /> XI N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p `m <br /> m n <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 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. <br /> S. 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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. c <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHENCtE <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z (� <br /> CONDITIONS OF PERMIT: c <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. t <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 0 <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. <br /> �gf 2m <br /> 9OM <br /> c D a C5' <br /> 03 <br /> N N <br /> 7. Z : a U <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m 0C <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 v: m <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. -n <br /> m : <br /> m <br /> SIGN HERE <br /> ( =_ML04 <br /> rbuilding contractor) (date) <br /> ZONING ADMINISTRATOR <br /> cnvi to to t»t» <br /> C63 - N Nfn NNut UI <br /> P P O f!1 N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0000000 <br />