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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N O' <br /> N <br /> OWNERzjla Jtk-'t� TELEPHONE 7/e- j <br /> HOME ADDRESS — o- <br /> 3 � Q� Die/- ,SZI�dI rn <br /> EMERGENCY/FIRE NUMBER /ROAD NAME c7� lecl —T I <br /> LEGAL DESCRIPTION(see tax receipt) / V" �'�ll _A� /EF1/1 — — co <br /> / <br /> v � <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ co o <br /> TYPE OF PERMIT(S): I��` c <br /> Cr <br /> FILLING/GRADING (❑ CAMPING UNIT ❑ SUBDIVISION IVtil a <br /> STRUCTURE/ADDITION USE: �J Yn V / / la'2— / o' <br /> 0 <br /> �l (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) Cn <br /> BUILDING CONTRACTOR: r V � �!�PrfY)C/ OM <br /> Erv <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 /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p m <br /> n C- <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE 19 <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 Inn N" v <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. 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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. c <br /> v 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 � <br /> NEEDED. <br /> KI <br /> 1 <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. y 1 <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 /> ;u -U0 r 0 6 <br /> 'D M) m <br /> a C N y 0 0 <br /> 7. Z : w Ci <br /> o1< <br /> A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Zj p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m CD <br /> , : ;a <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other Q m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T <br /> G : <br /> m : <br /> SIGN HERE ' <br /> (signature <br /> 'of ner or building contr ct r) (date) <br /> W: <br /> ZONING ADMINISTRATOR <br /> to to f»fn� '"M l N NNNUI <br /> (r (r O U1 Vt 0 0 <br /> T NSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />