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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. 4 <br /> r <br /> v / /' / p �7p N <br /> OWNER P;,4xlC 0IZTELEPHONE HONE (d/�' <br /> CL <br /> HOME ADDRESS <br /> T 7 �(o /'OO.oN oCAH/e' NA ooWo'an 0 <br /> o �^ <br /> EMERGENCY/FIRE NUMBER q'7 ROAD NAME (7 D ++ ( n <br /> LEGAL DESCRIPTION (see tax receipt) ZD� ur <br /> J m <br /> TYPE OF PERMIT(S): DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ® PRIVY ❑ v o <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n4 - <br /> 5: b STRUCTURE/ADDITION USE: SC/z.CC,..) Pon-e-A 141DD "7"o j to X IZ <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) Cn <br /> fi <br /> BUILDING CONTRACTOR: A&/LTII/.L/`i vn 131-D-s :Zme—. fir �) <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O � <br /> m o. O <br /> -n o Z <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 NEW BUILDINGS(NB)AND INDICATE m9 <br /> NORTH(N). C O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 0 <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. \ (� o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO Q 1 ^ <br /> BUILDINGS, ROADS, LAKE, LOT LINES. D <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N I <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. I c <br /> v 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P X ) <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. \ v <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. �� 1 <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 /> 5. <br /> XT0r�io�O 'D <br /> rn <br /> 0 C N N C <br /> Ho . - 3 <br /> _0)i >a <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my � � i3 c m <br /> p <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 an accompanyingschedule and I further declare that I recognize m m' ; ': ? m <br /> PP ( 9 Y 1 9 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- 6: E E p <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 to <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T <br /> mf <br /> SIGN HERE <br /> (signature owner orbuildi c tractor), (date) <br /> r <br /> ZONING ADMINISTRATOR (/L�G7 E <br /> tntntnw"0 <br /> N N ill N N(/� V1 <br /> ftp fl1 O fJl (JI O O <br /> 9w, <br /> NSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />