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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 /> • - r <br /> CD <br /> CL <br /> N O <br /> OWNER 114/""r- /KP m Z':�- TELEPHONE !Z <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER 4-74 ROAD NAME �'C<SlTlO fJ/LEGAL DESCRIPTION(see tax receipt) Z y7 yy d'os�o �� C7 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION EZ PRIVY ❑ CO O 0 <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION a <br /> STRUCTURE/ADDITION USE:^N�N(� ZCA 911v, I t ei-i� r (1 CTT <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) m <br /> BUILDING CONTRACTOR: Eu G <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 61/a X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 G <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> M <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> T O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m �-A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C <br /> NORTH(N). Nof <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m " 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF t (/� o <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. 1 0 <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 � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: C <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 ol <br /> PERMITTED. TO <br /> T <br /> 4. NO STRUCTURES, INCLUDING RETAINING WAL ETC. LL UF�IlTHE REQUIRED WATER <br /> 5. SETB CKA e. �7b/2z1�Ok� / /� 60'v! 6� 4 �J eX � 2 s y <br /> �Sy �� / //� / �/ M _ d i0r� 0 <br /> s. D�'re 7�m / { `�� r'�i�� Y� /Io�7�o�fZ�r�./lrt� S �u�7 � ; a C 00 0 O' <br /> J , RCNmoS3 <br /> /�,/ N N <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Lj c C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m 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 am40 <br /> I <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 HERE ��—�'�� � • <br /> g ature of ow or ulldl c tr r) (date) <br /> ZONING ADMINISTRATOR . <br /> wEn<ntn4940� <br /> N N01 NN L" M <br /> VI P 001010 0 <br /> TOWN HIP PERMITS MAY BE REQUIRED 0 00 <br /> 0 0 0 0 0 0 <br /> 00000 <br />