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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 4 <br /> OWNER/1 Uc yTSA j L— TELEPHONE <br /> 1 i7 G1` <br /> HOME ADDRESS 3�3 "1 CEf•"�WETI-) 'DR (cn S-4 513 kt <br /> m r (nI <br /> EMERGENCY/FIRE NUMBER 3 C��� � if <br /> c V, W <br /> I ROAD NAME C' �tEV()(,,)F -H D� <br /> LEGAL DESCRIPTION(see tax receipt) Nle A/ S W yy � S 3p� T 440 A/i R 1,414 � <br /> rn <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORYSTRUCTURE� <br /> TYPE OF PERMIT(S): ADDITION ❑ PRICl) o <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ I�X I I _ a = (� <br /> STRUCTURE/ADDITION USE: . K� y' ct <br /> IfF12HI�'1G_� o ft» <br /> (Home/Cabin, Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: � <br /> fir <br /> � <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR LJv <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T 3 <br /> O (^ <br /> DIRECTIONS FOR PLOT PLAN DRAWING• (AERIAL OR TOP VIEW) '� c <br /> O c <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. _ <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEWBUILDINGS(NB)AND INDICATE m S A <br /> NORTH(N). C n <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 v <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Z <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 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS 0 O <br /> MUST BE SIGNED AND DATED BY THE OWNER. c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a L <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o p <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. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY I <br /> PERMITTED. � ^ <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. 6IL�K�- <br /> 6. m <br /> m � 3amx° _CL= ,'0 <br /> 7. N C N N 0 3 <br /> Z N N C <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my rn- m <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of 'm " _C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize C <br /> CD <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <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 ti <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. -n <br /> m <br /> m : <br /> SIGN HERE �6 <br /> (sl ature of owner o b ' g contractor) (date) <br /> ZONING ADMINISTRATOR <br /> fnN to4 UO <br /> (OT <br /> EnTOWNSHIP PERMITS MAY BE REQUIRED g go <br />