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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 /> N o <br /> OWNER i 1 e�� i—F(1 F.���.N TELEPHONE <br /> HOME ADDRESS I 3 t �� e �CeeR� �/IJ// G l O <br /> aIY31 ja OAD <br /> EMERGENCY/FIRE NUMBER ,� acaOAD NAME 1 <br /> LEGAL DESCRIPTION (see tax receipt) 3 � vv m <br /> CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION PRIVY ❑ Cn o <br /> TYPE OF PERMIT(S): o <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> ( � ��// / �^! <br /> S. <br /> STRUCTURE/ADDITION USE: REP\O C e �V\ /�J 0 <br /> (� Home/Cabin;Commercial Business; Bedroom; Deck;etc.) y <br /> BUILDING CONTRACTOR: L9v,l7 cL -- ��1�Se tk�) C qitl7`,'1+ <br /> v <br /> PLOT PLAN MUST BE PROVIDED LEAST AN 8 <br /> ILLEGIBLE <br /> X 11 SHEET OF PAPER. ANY INCOMPLETE OR PLOT PLANS WILL BE RETURNED. <br /> 3 <br /> NED. O 3 <br /> � y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o. _\ <br /> T r Z `\ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n d V\ <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m �? <br /> NORTH(N). <br /> 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 Z <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. O <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N f , <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. m c <br /> o � 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN / <br /> NEEDED. a �� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z (n <br /> CONDITIONS OF PERMIT: P VI 1 <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 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER �I <br /> SETBACK AREA. Vv <br /> 5. <br /> zI0r co m <br /> 6. 3 CL Ll m <br /> m Cao 3 <br /> o : <br /> cn m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Zj 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 I, e <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m mm <br /> M this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- t7 <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 y ; <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 /> m : <br /> SIGN <br /> (sig o owner or bZIdinontractor) (date) <br /> ZONING ADMINISTRATOR <br /> V7 0 N (TO0 <br /> N N N N l)N <br /> 01 O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />