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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator ' o 0 <br /> CD APPLICATION FOR LAND USE PERMITS 3. =- <br /> r <br /> O <br /> C <br /> OWNER G n TELEPHONE -36/�L7 m <br /> CD <br /> HOME ADDRESS � 26 ©� /1 111,E (2T SJ)'L jktWCn, ln4 F <br /> CD <br /> EMERGENCY/FIRE NUMBER / 7g ROAD NAME Qe2t i'0Sa"j ate, So_ <br /> Wl <br /> LEGAL DESCRIPTION (see tax receipt) <br /> Sc c. �5 ya is /.5 .lo T/ <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION IK PRIVY ❑ rn o' ' <br /> TYPE OF PERMIT(S): <br /> c <br /> FILLING/GRADING ❑ CAMPING UNIT SUBDIVISION L15. <br /> a <br /> STRUCTURE/ADDITION USE: �/4 (� /0• AW1 f6YO A)VO 0 3Z 0' <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) y j <br /> / n m <br /> BUILDING CONTRACTORCD <br /> : G3L _ jtJC, iu <br /> �, . <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/a X 11 SHEET OF PAPER. ANY INCOMPLETE OR � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O \ <br /> M � C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) Oa <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m v z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y L^ <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 9 <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 i <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 /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTORS TC.,THE PLANS I 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATI MA ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. h , z <br /> I <br /> CONDITIONS OF PERMIT: ' Y,�yy � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMITISSUANCE. CO <br /> 'YF� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 2ON//`/G 4JIV}, 1/ 5U V <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ' l/� �w <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. / <br /> llny �.�• m -00r- Oaf m <br /> N N N <br /> O <br /> y O O <br /> 7. o T ' m <br /> - <br /> rn : <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) c c <br /> knowledge and belief it is true, correct and complete. 1 acknowledge that I am responsible for the detail and accuracy ofn a <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognize rSs E fD <br /> . m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- Ufa` <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 I <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. (D <br /> CDm <br /> SIGN HERE — <br /> (signature of owner or building contractor) (date) T— <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED �T— <br />