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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 /> OWNER C7 r Y r4ea V�r TELEPHONE <br /> HOME ADDRESS W 5-q39 S.S d` Trc f S , -C-�/$ff d O <br /> EMERGENCY/FIRE NUMBER / O/ ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) N� S� �—% — y C <br /> m <br /> � n <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION El PRIVYN <br /> TYPE OF PERMIT(S): <br /> 0 <br /> ii <br /> FILLING/GRADING ❑ CAMPING/U�IT [I SUBDIVISION Elo. <br /> STRUCTURE/ADDITION USE: 44 O m C� o? /X I-1D LU/ �� [/{���� 5��� Aly N' <br /> (� (� <br /> (Home/Cabin; Commercal Business; Bedroom; k; etc.) u1 <br /> BUILDING CONTRACTOR: GQ r\/ �J e-a U e.'F lir <br /> v C <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 /> O , <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> ,n a <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n d <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m �? <br /> NORTH(N). <br /> n <br /> ca 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m a <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 <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o � ( <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED. 1� n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. C OI o Q <br /> CONDITIONS OF PERMIT: fh <br /> � I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT aj <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 1 W p <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 LWI <br /> SETBACK AREA. <br /> 5. <br /> Q �. m m m <br /> 6. <br /> R CL <br /> CL M <br /> P : <br /> 1 cn m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of � CL <br /> m c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 'zt <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized perso to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> SIGN HERE <br /> sig lure of owner r Iding contractor) (date) <br /> ZONING ADMINISTRATOR <br /> N <br /> e 0,FnN to <br /> U1 N O <br /> (11 O (!1 U1 O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />