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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Admin atiSr 0 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> R� <br /> tll <br /> N <br /> C <br /> OWNER Cl/F S ? /Y 4R �' TELEPHONE <br /> o L]o <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER 7 a7 ROAD NAME )/i �_ I ' <br /> Se,� 3! -T� ,yo I(O !,dl�3� V( '16a <br /> LEGAL DESCRIPTION(see tax receipt) alt C•��yi [ 4/ <br /> e <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY 0 <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIV SION ❑ Cl <br /> STRUCTURE/ADDITION USE: 7tw G✓�( t. IodL 'ala / V &,-u 3 <br /> (Home/ bin; ommercial Business; Bedroom; Dec etc.) <br /> BUILDING CONTRACTOR: �U V1? lit n <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 61/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 G <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 N _ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) Om <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m v p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). co 0 <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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. P <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO O <br /> BUILDINGS,ROADS,LAKE, LOT LINES. UJ gJ <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 1 N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR,ETC.,THE PLANS J( <br /> MUST BE SIGNED AND DATED BY THE OWNER. to <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q �, <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: (�) <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT (� <br /> ISSUANCE. p <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY p� <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. �<`'I,�.��,�,I\ _.�P.i- I_- /� r `r m m + two Intl <br /> 6. ..3JI o el `(�'1 ��_ge l�G'U�U1�1 � 1 —PS lay'Y-?,�� 3 a 0 i a <br /> fp N C N w p 3 <br /> Zi m eo �M 'i <br /> O <br /> 7. CA m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my a; G� A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of �: n B ; C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m : m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m O <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 spree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have acceA to the above described prepilisses at any reasonable time for the purpose of inspection. -n <br /> m : <br /> SIGN HERE n <br /> (sign atur f Wner or buildtn9 ontractor) (date) ` <br /> ZONING ADMINISTRATOR <br /> 01 <br /> / rwfnwf»cn 1 <br /> P�u, o01 <br /> Jv <br /> N NN N fn0 o <br /> `TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 o 0 <br /> 0000000 <br />