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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Rtl/ itr41or p o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N O <br /> N <br /> C <br /> OWNER Sj U 1i/@ t r©S Y7'V TELEPHONE -3 -3 23 S o <br /> d <br /> T- <br /> HOME ADDRESS 7 7p 2 / O 197W o Jt'D Bow�U / 1�S�7yL/tel v <br /> r M <br /> �o <br /> EMERGENCY/FIRE NUMBER t�!7� 2 ROAD NAME rQs ',W D Rep <br /> LEGAL DESCRIPTION (see tax receipt) — 7 —T j?8 • /S �J m <br /> e <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE�' ADDITION PRIVY c <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING CAMPINGUNI ElSUBDIVISION ❑ <br /> . a x �o y <br /> STRUCTURE/ADDITION USE: 0 <br /> -& <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) m <br /> BUILDING CONTRACTOR: E <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m n <br /> NORTH(N). m ° <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. 0 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Z N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 2 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o ) <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN S. ° <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o 0 <br /> CONDITIONS OF PERMIT: 'r <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT O <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 /> OL <br /> 3nmfic' Q A <br /> 6. � co c y N o � <br /> N O �O <br /> 7. o N �� <br /> _ ti ; , m <br /> (R� ', m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 3U G)c 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 any accompanying schedule)and I further declare that I recognize m m 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 m <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. -n <br /> CDm : <br /> 49 <br /> SIGN HERE <br /> (signature of o e r buildi co act r (date) <br /> ZONING ADMINISTRATOR 30 <br /> tflv+cnwwtn� <br /> N N01NNfT VI <br /> O 0 0 0 0 0 0 <br /> TO NSHIP PERMITS MAY BE REQUIRED ° <br />