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Burnett County 7410 Co. Rd. K, No. 102, Siren,W154872 Office of Zoning Administrator - a o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> rn <br /> � //1 /Y� <br /> OWNER 1/l ,\ iAt , 7 T v n 1� l 1 L��Yl TELEPHONE <br /> Ian <br /> m <br /> HOME ADDRESS Ja ^ (� t � v 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> Q Q') <br /> LEGAL DESCRIPTION(see tax receipt) C <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑_!ADDITION ❑ PRIVY ❑ --Zrn 0 p <br /> TYPE OF PERMIT(S): q' <br /> it � <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5 <br /> LA. <br /> STRUCTURE/ADDITION USE: t1)01 Irl o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> m <br /> BUILDING CONTRACTOR: / <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. ��D IGL�Gr /� <br /> 00 io <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) �O-5 �j ys G 0 Q v <br /> � <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Z <br /> ✓ n d Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 9 <br /> NORTH(N). <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m3 <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. ` <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 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. m o <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN 1 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. ` , I <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 /> X *U0r- ov <br /> 6. 3 nm 3Ea <br /> mCN !" o� 3 <br /> 7. Z mom : <br /> o ? ;c <br /> 1 (n m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c ID <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of }� m 0 C <br /> CL <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m E m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is 8w' : O <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 ojoj: i m' <br /> ` ` : <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other cn <br /> authorized person to hive access to the above described premises at any reasonable time for the purpose of inspection. n <br /> SIGN HERE IL <br /> (s at a of w building conVactor) (date) <br /> AA <br /> ZONING ADMINISTRATOR <br /> Fn+nv+wwcn� <br /> N NN N n1 <br /> NPl1 01 <br /> ( 00 P <br /> TOWNSHIP PERMITS MAY BE REQUIRED 6 <br /> 00000 <br /> 0 <br /> 0000000 <br />