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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator _U o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> to O <br /> CD <br /> OWNER �^ES `�{a1J/¢ Ay�C?ti TELEPHONE 7/5 06 'Z/-5 p <br /> HOME ADDRESS <br /> o <br /> EMERGENCY/FIRE NUMBER 54i,,.x & ROADNAME <br /> / P <br /> LEGAL DESCRIPTION (see tax receipt) /0( S= S �d �9 �b <br /> i <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ C <br /> c � <br /> TYPE OF PERMIT(S): <br /> n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: l/J/NL ' <br /> (Ho /Cabin; Conw3Arciai Business; Bedroom; Deck; etc.) Cn <br /> I C44 <br /> BUILDING CONTRACTOR: <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 G <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. ® ({ 1'r �J���! CDc <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 7 J t S L I�' n OL <br /> 1 m Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m o <br /> NORTH(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. <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 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS 2, �c <br /> MUST BE SIGNED AND DATED BY THE OWNER. :OE UJ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> o <br /> NEEDED. Q� <br /> Z I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ° CN <br /> CONDITIONS OF PERMIT: UL <br /> I. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT R 1 <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. (J d"� ) " <br /> 5. n/of l — V �hp m m d a £ m <br /> o � 3nc@ 0LL <br /> 6. � mcv`", mo � <br /> 3 <br /> o ?t m <br /> 7. <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 0 c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of Q m c m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognizeCD <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- (j <br /> sue a permit. I further accept all liability which may be a result of the C t of Burnett relying on this information I am <br /> v <br /> providing in this application. I agree to permit county officials charged i h I r t r¢ $rts s or otherCD <br /> authorized person to have access to the above described premises at an r e r h r spection. - . <br /> ;i <br /> SIGN H Cr r�y 1 (dat ) <br /> ( ' natur of owner or i contractor) <br /> ZONING ADMINISTRATOR ljq4 <br /> TOWNSHIP PERMITS MAY BE REQUIRE�GNENG 014 p' I `j <br />