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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v c) Z <br /> APPLICATION FOR LAND USE PERMITS 3 ° <br /> 1 � 0- <br /> OWNERB U rn h n n;� ID TELEPHONE P 3 �8S�t3 <br /> O 6 / v <br /> d <br /> HOME ADDRESS O <br /> >�l'n rEhcc , <br /> EMERGENCY/FIRE NUMBER Do ;Ire- 44-640d- w <br /> ROAD NAME 5 0,N) <br /> LEGAL DESCRIPTION (see tax receipt) Co m p tt L6r- O �O 9 3 Sb O sZ (4 Q p m <br /> LU 0 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ PRIVY ❑ ( o <br /> TYPE OF PERMIT(S): co <br /> FILLING/GRADIN <br /> /C�/❑ CLAMPING UNITE] SUBDIVISION ❑ q <br /> STRUCTURE/ADDITION USE: Vr71�1(n� pu{�X � <br /> o' <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) m � <br /> m <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR B <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. Jt - )g 0 � In H <br /> J O Q <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) SC ,ter /11pG, Qaf n c <br /> or' l u{ 0 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. mh <L. �l in Z <br /> d <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND1 I m (? <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) O m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <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. S c <br /> o � \ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHENq o <br /> NEEDED. Er <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: 9 �� \ <br /> O <br /> I. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. Sb <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 /> ETBACK AREA. <br /> X v0 =� 0 <br /> CD mCD <br /> (D C 01 y 0 j 3 <br /> o .0 <br /> —y: : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) c : p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m E' C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is m m <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. -n <br /> S- - <br /> ADO 0 C <br /> C : <br /> �,�� � <br /> SIGN HERE -�I eZ'la•-t:�.�1n <br /> (signs r of ner or buildi g cntractor) (date) oo � <br /> ZONING ADMINISTRATOR <br /> N <br /> wwcncnfnr»� <br /> N NfT NN (n CT <br /> V1 fP OfT (700 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 000000 <br />