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C�n' y <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 ci z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> y O <br /> N <br /> C <br /> OWNERn TELEPHON n <br /> IAC e�i orc� and kr i s lc� ,L r r, �61a2) <br /> L I / p � <br /> HOMEADDRESSa3l�/� G�4 ST t"or�/ cl �/ `✓`1;fG r�Ea.^�4/�t 1 10 v <br /> `/K 3631 <br /> EMERGENCY/FIRE NUMBER ROAD NAMEI <br /> o s 3 �� Coun' y �7wv� <br /> LEGAL DESCRIPTION(see tax receipt) moy <br /> DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ ' ur <br /> TYPE OF PERMIT(S): � <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5 <br /> STRUCTURE/ADDITION USE: CeLh i n IIIJJJ <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) or <br /> BUILDING CONTRACTOR: <br /> v <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. T <br /> 70 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> �Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C1 obi <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> C <br /> NORTH(N). y <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 <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 �Q <br /> BUILDINGS, ROADS,LAKE,LOT LINES. 1 <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 (I t <br /> MUST BE SIGNED AND DATED BY THE OWNER. ( o qJ <br /> o � 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHENq G <br /> NEEDED. T <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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 1 <br /> PERMITTED. QO <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER 1 7 <br /> SETBACK AREA. <br /> 65.. NsjLe' 8'C; -do 44S d '-y" foo' -�L ,�� � -a3 n�0 a im <br /> � Cu"i " o� 3 <br /> 7. Z ' ym °�0 ,moi <br /> o : <br /> 1v,: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of (9/� u c <br /> all Information contained in this application(including an accompanyingschedule and I further declare that I recognize <br /> 1' m <br /> PP ( 9 Y ) 9 � . . :: m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- p <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. m ': <br /> m : <br /> SIGN HEREr`�/'� C/ <br /> (sIgnatqLe_0 owner or building contractor) (dat <br /> ZONING ADMINISTRATOR . . ' ' ' . w <br /> N N (IINN (71N <br /> N O N N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED ��" %// 0 0 0 0 0 0 0 <br />