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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v z <br /> APPLICATION FOR LAND USE PERMITS CD ° <br /> 0 v <br /> y O <br /> OWNER a[ffJI ItJl9�yE:g TELEPHONE �S1 CJC)' /� <br /> HOME ADDRESSala <br /> !;0 W A eW ILV A i T eP UL PjI J" S.S/Cly ' <br /> EMERGENCY/FIRE NUMBER q 4-1 ` ROAD NAME lj"to L4" a_6Ut T m <br /> LEGAL DESCRIPTION (see tax receipt) t` <br /> L ffr S 21 �reUr+���1 P �S N �'1W P •rf�s Q <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE AL ADDITION ❑ PRIVY ❑ Cn 0 <br /> TYPE OF PERMIT(S): d <br /> FILLING/GRADING /❑ CRAMPING UNIT ❑ 'SS BBDDII�VISION ❑ <br /> STRUCTURE/ADDITION USE: <br /> � (Home/Cabin; Comme cial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: S ct Pm�'t uj Sm 0 az tic,s U <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/z X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n - <br /> p — <br /> M y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p <br /> -n o <br /> z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> t7 m � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C <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 <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. Q <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS \°� <br /> MUST BE SIGNED AND DATED BY THE OWNER. 5' o <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. oz �J <br /> CONDITIONS OF PERMIT: <br /> I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT "y <br /> ISSUANCE. ' Q <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 /> S r �1'j� above. )I"�� 1 ' 1 �J�� M v 0 0 o a � m <br /> 6. 1 f ( , rte' r-si -. � 3 n m x L c5 <br /> 7. 1 + � li Z : in m o : <br /> : A <br /> I declare that this application (including any accompanying schedule) has been e d b ' tq test of y C) , <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am respons' p for the detail an curac o m <br /> all information contained in this application(including any accompanying schedule)an K a e that I reco n <br /> CD <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in Ail o - C <br /> C) <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett rely ir .�++!!++forrtldti6n I am <br /> providing in this application. I agree to permit county officials charged with administering county ordlt9ances or other <br /> authorized person to have access to the above described pigmises at any reasonable time for the purpose of inspection. m <br /> m <br /> � <br /> ID <br /> SIGN HERE zoo <br /> (signature of own building cont c r) (date) <br /> ZONING ADMINISTRATOR <br /> 7 �l <br /> TOWNSHIP PERMI S MAY BE REQUIRED V <br />