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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N ti <br /> CD <br /> OWNER CH,9 fe,1 �5- 13/=/� Tll� TELEPHONE 6 t Z f37�� 3 0 <br /> /� m <br /> CD <br /> HOME ADDRESS y 4 yVF S .v OL S S v <br /> 7<S 2.� —3362 M rr/ ` <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> / I <br /> LEGAL DESCRIPTION(see tax receipt) T/oA,/id Vo)'A6£/?, ^ <br /> OF- 'Corr. 8U2A/E?j G'ot/•oorX S�aij< V m <br /> � � <br /> DWELLING/BUILDING o GARAGE/ACCESSORY STRUCTURE 1:1 'ADDITION ❑ PRIVY ❑ i m <br /> c <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING <br /> /� CAMPING UNIT El S'UW of /BDIVISION�❑ m <br /> STRUCTURE/ADDITION USE: /762 /,R/1 �'7 — LYW(JL1 0 J <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) 0) <br /> BUILDING CONTRACTOR: <br /> Z � <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 61AX 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> 700 N ' <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n C <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 5 m z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m :° <br /> NORTH(N). CO) o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m \ 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. l o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO nj <br /> BUILDINGS,ROADS, LAKE, LOT LINES. 9 <br /> It* <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR,ETC.,THE PLANS I <br /> MUST BE SIGNED AND DATED BY THE OWNER. so I <br /> O s <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN m 0 n <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: CZ <br /> v ' <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 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> oc/dA&� M _ m <br /> 6. v d <br /> 3 m x 0 .G <br /> mC N 0 � 3 <br /> r� <br /> 7. A <br /> = N m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my cj c C <br /> knowledge and belief it is true, correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of 61 c E' i <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m A <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- y 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 i s pplicati n. I agr a to ermit county officials charged with administering county ordinances or other m <br /> authorized/per to hav ccess to he above described premises at any reasonable time for the purpose of inspection. m <br /> m <br /> SIGN HER `-�✓i/�� <br /> (at nature of owner or buildigg contractor) (date) <br /> ZONING ADMINISTRATOR61 <br /> fn <br /> wucn cn Fnw� <br /> N NfT NN (n(T <br /> Cn NON (/ 00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 0 0 0 <br />