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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 /> W O <br /> r c <br /> OWNER0-# <br /> TELEPHONE 715 <br /> m <br /> HOME ADDRESS 3614'5 MI A' lr✓0., IJ,�M1 �cY • , �2�r� <br /> EMERGENCY/FIRE NUMBER I ROAD NAME M1 nei1VA- <br /> LEGAL DESCRIPTION (see tax receipt) :51,j y S SP GYi ort aZ(o T N/ M-R /G l✓ a <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ rn 0 <br /> TYPE OF PERMIT(S): cr <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION ❑ n' <br /> 5. 1 <br /> / N <br /> STRUCTURE/ADDITION USE: f Ta I'M n� it)a`j / c/'^A I nl —� <br /> (Home)lCabin; Corilmerbal Busine ; Bedroom; Deck;etc.) U) <br /> Q / �J � <br /> BUILDING CONTRACTOR: /t Gh HGt-yx0rV E <br /> v <br /> nr <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> �1 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O c <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 n <br /> NORTH(N). y 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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. ISI <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. 'o c <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Ct <br /> NEEDED. 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c Q <br /> CONDITIONS OF PERMIT: Q Y <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT � �' <br /> ISSUANCE. f f V, <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. V" <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 /> no�o m <br /> 6. No C 4ojA1,6 ( );T-ojrJ 5o F or- o,eo;N� rt 614-W n'�Rpl� C �o <br /> I U 0"-7Vf3E — '�S�Er- Dm O�D/N t�iE;rlZ (CAD <br /> = m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ](, G3 c IS <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of v 1 a C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <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 <br /> providing in this application. I agree to permit cou officials charged with administering county ordinances or oche m <br /> authorized person to have access to the above desa ibe p mises at any reasonable time for the purpose of inspection. T <br /> �f to <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR �Hn14 h l li Re e+ <br /> vt fn v+v+w w <br /> N N N N N CA U l <br /> (T (JI O (JI fn O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />