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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> 4 APPLICATION FOR LAND USE PERMITS 3. <br /> _ 0 <br /> N ti <br /> UI <br /> c <br /> n <br /> OWNER 1) cfenz,r TELEPHONE <br /> m <br /> HOME ADDRESSOwg , <br /> EMERGENCY/FIRE NUMBER $� V 9 ROAD NAME <br /> ! 1 <br /> ( P) Co+ 5,6 C 441 sy l Y T 5�6AJ /5 W SU y <br /> LEGAL DESCRIPTION see tax receipt) <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION 04 PRIVY ❑ y 0 <br /> TYPE OF PERMIT(S): c <br /> Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5 <br /> H <br /> STRUCTURE/ADDITION USE: L/✓�f1G, <br /> 1� �Ho m CaH l bin; Commercial Business; Bedroom;"Deck;etc.) m <br /> BUILDING CONTRACTOR:_ /�/ n( <br /> 0CD <br /> J <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 /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T ii <br /> m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Z <br /> M z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). \ \ 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO Mv <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 l <br /> BUILDINGS,ROADS,LAKE, LOT LINES. —�j D <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 1 N �l <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 0 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. 1 <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 /> z - 0d ov <br /> 6. ma <br /> .ov ' <br /> � f�D C H y G <br /> 7. Z : m M '1° <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my i3 c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofCL <br /> m c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ! m m <br /> O <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 pr ises at any reasonable time for the purpose of inspec on. .n <br /> m : <br /> Q m ; <br /> SIGN HERE / 40qy <br /> (sig u of or b�u ding con-lrraactor) (date) <br /> ZONING ADMINISTRATOR m <br /> cn fn 44,64'A fn <br /> � Ga � l ''1 N NfnNNN (T <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />