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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -CD o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> — r <br /> y o <br /> N <br /> OWNER e p 51�/�yC/SOfy TELEPHONE 86� _ 7s'd y d W <br /> HOME ADDRESS '2 78 ?7 /�UyA/^ //� /C [/ �dS%CI !�! �j� 3 v 9 <br /> r CD <br /> EMERGENCY/FIRE NUMBER 97 817 ROAD NAME <br /> L 1 Csrn V 1 Pa c), GL3 as yo-1s <br /> LEGAL DESCRIPTION(see tax receipt) (� ( ti <br /> DWELLING/BUILDING ISI GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ m o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: yY9/21 e- 0 I/� 7-V 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) u, /� <br /> BUILDING CONTRACTOR: �e �; 1 Ll <br /> CDv <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR �I 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) '_1 0 a <br /> ?� Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE 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 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF r <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N 1 <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. o <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o <br /> I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Q <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 1.71 <br /> SETBACK AREA. <br /> 5. <br /> 6. m 0 n m <br /> 3 n 0 1 <br /> mCmyoS3 <br /> 7. N <br /> P z <br /> m ' <br /> P <br /> — rn : [ m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G1 c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of �+ c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize mm 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 /> m : <br /> SIGN HERE <br /> ign ure of owner u Ing contractor) (date) ti <br /> ZONING ADMINISTRATOR fn <br /> cn cn cn w w v� <br /> N N Vt N N VI u1 <br /> V7 C11 ON 6I1 OO <br /> TOWNSHIP PERMITS MAY BE REQUIREDo o C G G G <br /> 000 000 0 <br />