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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N O <br /> VI <br /> OWNERt1rL) TELEPHONE n <br /> 7/S- 6 r6 - 3ad a <br /> HOME ADDRESS 5`0 35" �L1EL 5 /KA I !7 /1�UURY /l �d/W3p v <br /> .tom <br /> / 0 <br /> EMERGENCY/FIRE NUMBER �Q 3S` ROAD NAME 19 jZ I J'gg/ ~ <br /> LEGAL DESCRIPTION(see tax receipt) �� gQ fi �I+�1�Iv��0 � 0�n, -, �q 06 y <br /> 1 <br /> DWELLING/BUI DING EETGARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ m � <br /> TYPE O ): a r <br /> FILLING/GRAD G ❑ CAMPING UNIT ❑ SUBDIVISION El S.5 �\ <br /> STRUCTURE/ADDITION USE: o' <br /> �} (Home/Cabin; ommercial Business; Bedroom;Deck;etc.) m <br /> BUILDING CONTRACTOR: V I l `C�(�ES 7 '�j(�(Z`� � — I 6{ <br /> v <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. O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> no. <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. a roOi 1p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). ti o <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. 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. UJ <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> N C� <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. <br /> v � � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHENa o p <br /> NEEDED. �y <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c ( ' <br /> CONDITIONS OF PERMIT: Q <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT OG <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. W <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. /� e <br /> 5. 5 110�ANK beA� �f?cR�j` -S-Tri- dJk�GGLI z -0 0 iu o il.o v <br /> 9 (Dcm W0 � 3 <br /> Z : " <br /> 7. <br /> o <br /> 1_ 0): I m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Zj c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of t� m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m a E E m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- L�jM <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. <br /> 1p <br /> SIGN HERE <br /> (signature ow erorbuildin clog (date) <br /> ZONING ADMINISTRATOR ' <br /> oU1L" o <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0' o <br /> 0000c o <br />