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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N O <br /> f/1 <br /> C , n <br /> OWNER DGut e— TELEPHONE (p (Z- �-Z� _�� IJ o e L 1 <br /> CD <br /> HOME ADDRESSl I <br /> 1 l 124 �+llAe.,�Pc- 19 UE � e'1Giw,pilae'i I°✓(Il�. S� 3:2(o r <br /> i 0 <br /> EMERGENCY/FIRE NUMBER 3y(oS ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) . /1 a O ` v �o�q�..(J OC 7-- <br /> I � <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE 1:1ADDITION ® PRIVY rn 0 <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ - <br /> n p N <br /> STRUCTURE/ADDITION USE: `/X 04 SCR. Pb ,i / (P X2c, 4z"-L 0 (� <br /> (Name/Cabin; Commercial Business; Bedroom; Deck;etc.) U <br /> BUILDING CONTRACTOR: Ne t , Pia vt <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81AX 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> M y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 0 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> C <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 Z <br /> 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 <br /> o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS pI <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN V ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> O <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 S!j0 L1N11 I f _ kaj <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFI YrC_j <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN TH�� QUIRED WATER <br /> SETB CK AREA. J ��. <br /> 5. (/ l e� .�vpD 7�0 4'UY'� y�?�� 4G. _ I oD f m <br /> 6. � 1 ' ' (1/11A,^yJ�1)��CJ SIJ m n m - . 'C <br /> `O N N <br /> 7. WI Qp u -aV �v1/j/YCJLI �` / N�7�{ o y ° <br /> v : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 1 C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize �{ <br /> PP ( 9 Y ) 9 tom' fD CDp <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- W <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 h acce a above described premises at any reasonable time for the purpose of inspection. -n <br /> m <br /> 69 <br /> m , : <br /> SIGN HERE 7 <br /> (sig ure of ow r building contractor (date) <br /> ZONING ADMINISTRATOR / \ <br /> TOWN IP PERMITS MAY BE REQUIRED <br /> �yV tL� Cyd <br />