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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 /> La N <br /> OWNER Yx� fJ �� TELEPHONE p <br /> m <br /> HOME ADDRESS Weis <br /> EMERGENCY/FIRIVNUMBER ROAD NAME 1 <br /> LEGAL DESCRIPTION (see tax receipt) �Q '�() /V� cskn 069 ra CO <br /> CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ 0 <br /> c <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION <. <br /> CSir� V lg -71" -79 N <br /> STRUCTURE/ADDITION USE: ° <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) (_� O <br /> 2. <br /> BUILDING CONTRACTOR: p� / I\'fir k 1 <br /> m �S <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T B. <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n n UJ <br /> T 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 INDICATE mo <br /> NORTH(N). 3 <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 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 <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N p <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. ° ° <br /> O � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN ° <br /> NEEDED. Q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. a O <br /> CONDITIONS OF PERMIT: }�C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT �` I <br /> ISSUANCE. I <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 Q <br /> SETBACK AREA. <br /> 5. DODO m <br /> CD °� 0 CCD <br /> CL <br /> `° <br /> 6. 3 <br /> a mcN `� ° 3 <br /> o om <br /> T`< Z1 <br /> 7. - :cn : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G> 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 /> ° <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CD <br /> 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 /> C) <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 <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. <br /> CD : <br /> SIGN HERE <br /> (signature of owner or building contra ) l (date) <br /> ZONING ADMINISTRATORt <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />