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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrate "l O <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> m o <br /> N <br /> OWNER �u�h OG K TELEPHONE 3V_ a4& g <br /> o <br /> I II <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER L4 13 y ROAD NAME �QNIP SJr�h fpti� o <br /> ^ dd n� <br /> LEGAL DESCRIPTION (see tax receipt) ,` �, L of pN —I C m <br /> n <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ (n 0 <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> . , <br /> STRUCTURE/ADDITION USE: Si rLK�2 /� lowcn.11try( 0 <br /> (Home/Cabin, Commercial Business; Bedroom; Deck;etc.) Cn r , <br /> BUILDING CONTRACTOR: C I m <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> See 5 + astis� M yCQ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 0 <br /> n <br /> M Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATECD 0 <br /> C o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m B <br /> 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 OGS <br /> BUILDINGS, ROADS,LAKE, LOT LINES. nt, <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. �j 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. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN O E <br /> NEEDED. 51 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o .— <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT p <br /> ISSUANCE. �1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. p <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY p. <br /> PERMITTED. G <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK QRE <br /> A = 0 M. Dv f m <br /> _ m <br /> 6. CO a n F = <br /> Z (D <br /> 7. .0 T� <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of a <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> CD : <br /> CD <br /> SIGN HERE <br /> (signature ofo er r building contractor) (date) i <br /> 6 <br /> //�' /� 3 <br /> ZONING ADMINISTRATOR /17 L r <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />