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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 0 Z <br /> APPLICATION FOR LAND USE PERMITS, 3 <br /> I l 3D7; S'�{ ' �1lusSB��u/� <br /> OWNER Cy( PS R Cern UN p2 fSD/v TELEPHONE GJS y/ ?j ! 3 s v <br /> m <br /> ,�/� N <br /> HOME ADDRESS ��g q ) 1 )„fU Q J-Vr,, C e <br /> m <br /> EMERGENCY/FIRE NUMBER ZC1 g 6q ROAD NAME e-f U-c, <br /> LEGAL DESCRIPTION(see tax receipt) <br /> 36 -LI — i6 S Lkl N w 4L S m L) i x m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ® ADDITION ® PRIVY ❑ <br /> TYPE OF PERMIT(S): d Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5 <br /> /C <br /> STRUCTURE/ADDITION USE: #aL"A/CC' hl Ct r4 <br /> (Ho /Cabin; Commercial usiness; edroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: <br /> M <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> c \ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <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). y fo 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDINGS)TO mCENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N t'i <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. I U o <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q ° r� <br /> NEEDED. W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> 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 jV <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED <br /> yWITHIN <br /> /THE <br /> [R�EEQUIRED WATER <br /> 112' <br /> 5. <br /> SETBACK <br /> AREA. <br /> �� "�TN �/ALJ aprz�//�'J/�� a h m 3 n Ow a � <br /> coo <br /> 7. Ct ;1a �y/t///G .P p yzlC : _� � <br /> 7 . Cy-- = rn : m <br /> I declare that this application (including any accompanying schedulej has been examined by me and to the best of my t7 c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofm C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognizeCD <br /> 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 <br /> providing in this application. I 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. m <br /> m : <br /> SIGN HERE <br /> (signatu a of oyper or uil ing contra to) (date) <br /> ZONING ADMINISTRATOR `C�`� !y I. . . . . . t� <br /> �N N N N N <br /> V7 N O . V OV7 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 00000 0 <br /> r� <br /> P <br />