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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 0 to <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N O <br /> UI <br /> CD <br /> p a <br /> OWNER KA f-, EN Cr- gVA 15 TELEPHONE bpi I^ 430'-0(03 0 <br /> • ' verC� -7l5- V56 -301 o� <br /> HOME ADDRESS "),0101 MA(Z(�.lE Ci�2�-Lr oV1 <br /> EMERGENCY/FIRE NUMBER 11566 ROAD NAME 6 LF p V)r tq (N �- <br /> LEGAL DESCRIPTION(see tax receipt) LOT a— (-5MVCj P Op ur <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION PRIVY ❑ c 0 <br /> TYPE OF PERMIT(S): v <br /> cr <br /> FILLING/GRADING 11CAMPING UNIT 11SUBDIVISION <br /> // • <br /> STRUCTURE/ADDITION USE:C —64 V^-- <br /> (Home/ in; Commerciffl Business; Bedroo ,Deck;etc.) rn <br /> BUILDING CONTRACTOR: '"�D/�M <br /> M Z <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR In 3 O <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. jn�y`,'f_� 0 — <br /> U -n c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m d O 30 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m o <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF c <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 /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR,ETC.,THE PLANS ? 1 <br /> O <br /> MUST BE SIGNED AND DATED BY THE OWNER. 1° 9 <br /> o w <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. t"^1 <br /> 1 <br /> ° <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ° <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT lj <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. ��� /J� � <br /> 5. y(,/c]� I�/V V"' C..[� m m d 00 F m <br /> I I 3 Earn x �d_ ;a <br /> 6. <br /> QC093 <br /> m N7. Cn O <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �j! L7 c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> L� O <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. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am o <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. - <br /> m : <br /> ?-000 <br /> SIGN HERE date <br /> (signature ner or uild c tra or) ( ) <br /> ZONING ADMINI TRATOR OI Cn N N d'N 0 <br /> N N 0 OI <br /> Ol (T O N PO o <br /> O 0 0 0 0 0 0 <br /> WNSHIP PERMITS MAY BE REQUIRED <br />