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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 /> (1 1 <br /> m 0 o }LJ <br /> CL <br /> U) (� <br /> OWNER - eC r " e. �� TELEPHONE O -xJ <br /> ,< <� eAS 14 e r s r <br /> HOME ADDRESSA(Oinrt oI n u d 41 e_ 2'L eSr9/O R <br /> 0 <br /> EMERGENCY/FIRE NUMBER y 8 ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) g a a as �• <br /> Ty©/R�y cy <br /> y� <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE IrJ`i ADDITION ElPRIVY El ) rn 0e <br /> TYPE OF PERMIT(S): < M <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> ( y <br /> STRUCTURE/ADDITION USE: c�r�4� 3o o <br /> (Ho Nee/Cabin Commercial Business; Bedroom; Deck;etc.) rn <br /> Ct <br /> BUILDING CONTRACTOR: -e£'el e R t o N <br /> C <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. G <br /> A N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. t7 m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). y c <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 .r" 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 <br /> BUILDINGS,ROADS,LAKE, LOT LINES. (7-1, <br /> S. 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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. U3o t <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q 0 <br /> NEEDED. 0 Q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: G <br /> 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT J <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. <br /> 5. <br /> zv00) <br /> 6. m � 3 am Ox � <br /> g: C N <br /> 7. o ^ ZM,< Pi <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my uj c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of JCL C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize . <br /> M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> ro <br /> ro <br /> SIGN HERE <br /> (signature of qwper or building contractor) (date) <br /> ZONING ADMINISTRATOR . . . . . fn <br /> vicncpcnwf»� <br /> N NOI NN OI <br /> OI 010NN00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED oC�o 0 0 0 0 <br />