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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> (o - 33,.Df r SIN <br /> OWNER <br /> N O V_ <br /> H <br /> � """2 C <br /> / y�� �h d <br /> OWNER o.L�/ � � 7/�� TELEPHONE � o <br /> �? <br /> HOME ADDRESS O$ (� v(� 1 �2d cvls�_ 0 <br /> QQ `t m <br /> EMERGENCY/FIRE NUMBER (0O�t� ROAD NAMErn(ele L/q Lardq a 1 <br /> LEGAL DESCRIPTION(see tax receipt) V L 5-& L I/a CSrn V S-Pl Da --.26-q -l(, / <br /> W n <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ I v7 ° <br /> TYPE OF PERMIT(S): Ca <br /> FILLING/GRADING ❑ CAMPING IgIT ❑ SUBDIVISION ❑ <br /> L' <, <br /> STRUCTURE/ADDITION USE: �i✓/t3'1- <br /> (H a/Cabin; Commercial Business; Bedroom; Deck; etc.) U) UC1 <br /> m Q <br /> BUILDING CONTRACTOR: �[? <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. m -' <br /> O <br /> 0 in <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) — �" - �)�. O m (R <br /> Slv(�r�ow� T o `�1 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. i7 1 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m !F <br /> NORTH(N). y (CC�y�� o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m ?i', 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF /yam U ` <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 1 ' <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO C <br /> BUILDINGS,ROADS,LAKE, LOT LINES. /C�c <br /> 0 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N n <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS w <br /> MUST BE SIGNED AND DATED BY THE OWNER. o I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a ° <br /> NEEDED. ° <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT f/ <br /> ISSUANCE. n 1 I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. XJ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Q <br /> PERMITTED. GO a <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER O o <br /> SETBACK AREA. <br /> 5. Q / �/ <br /> rn(�S c,� �L� f}s��/ ��UrsY/�4 <br /> A 17 0 O m <br /> n <br /> 0 F m <br /> 6. ;Or <br /> 24 <br /> 7. Z N <br /> O <br /> ly: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my of- ID <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recogniCD <br /> ze CD <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- d O <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 m : <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m E <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T <br /> m <br /> SIGN HERE ' <br /> (si a re of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR <n <br /> N N N N N V t N <br /> U7 Oi O Oi N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED0 0 0 0 0 <br /> 0000000 <br />