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Burnett Ccunty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 00 o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r n . <br /> dS/ 4M Y899 a <br /> OWNER 41 A14 z 16 44 ye/-/-7—A-,L C te TELEPHONE 6s/ 2S j Or 4 o <br /> S� /�Y)�/►GM y /�V� .S/ �i¢t!L <br /> HOME ADDRESS Sv(J/ <br /> r m <br /> ry. ^/ J / / 0 <br /> EMERGENCY/FIRE NUMBER ,?rQ6� „/P�NOh ROAD NAME C/y� S.�O �! �(,V <br /> dot y es"" vo/ it � �,►s-7 Q <br /> LEGAL DESCRIPTION (see tax receipt) G�qo✓t '06-71' �/ �f 3� os..wr40 -i'9 Al /fwNw & �✓ m <br /> DWELLING/BUILDING ILEI GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY 1Y 0 <br /> TYPE OF PERMIT(S): ' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ CL r, <br /> JJ 0 U� <br /> STRUCTURE/ADDITION USE: SNaS o /1 w�� `q 9ih ° <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) rn <br /> BUILDING CONTRACTOR: SC o <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n W <br /> O <br /> CD <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a I <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m t� A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m AS V <br /> NORTH(N). N o _ <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 1 <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. Q <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o rl, <br /> o ?W�1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN T S <br /> NEEDED. Q hN <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o I`� <br /> CONDITIONS OF PERMIT: <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. J I d <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY pG <br /> PERMITTED. p� <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER v <br /> S TBACK ARE <br /> 5. 25 d� ace e arl� loe � �� ; - �r > o <br /> 3 aRV <br /> m m <br /> D <br /> - r=` A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my m nz C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of n <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize <br /> � CD O <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 6 of <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 Q <br /> providing in this application. I agree to permit county officials charged i ordinances or other <br /> authorized person to have access to the above described premises at a' r b e r e o�inspection. `D <br /> m : <br /> CD <br /> m <br /> SIGN HERE D �Q <br /> (signature of ow uilding contractor) 2 )W1 <br /> a .1 <br /> ZONING ADMINISTRATOR J WY! <br /> ETT COUNTY <br /> TOWNS P PERMITS MAY BE REQUIRWNING <br />