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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N <br /> f/1 <br /> OWNER R; cl pyc) Yh NOSDti� TELEPHONEOZY <br /> 1 ' <br /> HOME ADDRESS I I $ n LACK 6 U V-A/ S j?Q0Ale/C i dygo/p o/ ) <br /> r m <br /> EMERGENCY/FIRE NUMBER ROAD NAME O <br /> I ( l, �,Ac�< Qv ►�N ►2� <br /> LEGAL DESCRIPTION (see tax receipt)&L C <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE 11:1 ADDITION ❑ PRIVY ❑ 0 a <br /> TYPE OF PERMIT(S): c� <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: Y'ejA-+A ;Nlq Wq 05 ON IA ke �rodT �o ji <br /> (Ho a/Cabin; Commercial Business; Bedroom; Deck; etc.) (n <br /> m <br /> BUILDING CONTRACTOR: Kg U I;e x 11 t <br /> V' <br /> rie T ra?',oA. ProEET <br /> ' QST- �te i r• ec i-F cs►T o�✓S � <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8Y:X 11 HOF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n <br /> XI N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p m <br /> n a <br /> T O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m X <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). <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 <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 /> 6. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. IN ` <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 <br /> O � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> w <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o f'S <br /> CONDITIONS OF PERMIT: b I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 0 <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 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. [ <br /> �My_� '&r44. 1 1' <br /> 1 <br /> �u��¢ l<^�+- CD M. M D o a f m <br /> 6. CD <br /> CA-0,361ti r- / CD <br /> lir mC � 0S3 <br /> 7. o m <br /> - m m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my \ C) C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m 0 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- Gj <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 o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> -n <br /> (D <br /> q N <br /> SIGN HERE <br /> (s' na re of owr buildingContractor) (date) <br /> ZONING ADMINISTRATOR �I <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />