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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872Office of " G <br /> APPLICATION FOR LAND USE PERMITS Zoning Administrator 3 0 <br /> r <br /> AQ( <br /> OWNER nCe.fl.4/P/ TELEPHON_l <br /> HOME ADDRESS al���l5 Sau//Qe QI�IJQ�sr'�g(%� �yy SJrpo2S r 0) <br /> EMERGENCY/FIRE NUMBER ROAD NAME Ca, /QO/�0 ,, (h 1 <br /> LEGAL DESCRIPTION(see tax receipt) <br /> HE/ sec, y yv,v 6 A/ Da tayT cn <br /> CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ c <br /> TYPE OF PERMIT(S): 0 <br /> c <br /> FILLING/GRADING El CAMPING UNIT ❑ SUBDIVISION ❑ Cr <br /> 0. <br /> STRUCTURE/ADDITION USE: STD,eg r-Iuj/���/Gi x<13 S. <br /> y <br /> 0 <br /> � (Home/Cabin, Commercial Business; Bedroom; Deck;etc.) 07 ' <br /> BUILDING CONTRACTOR: 'JEl-�� S�LLf7f,B,(� �� 3Jae& R�5 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 71 SHEET OF PAPER. ANY INCOMPLETE OR m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n 3. <br /> 6 AERIAL OR TOP VIEW) O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n c. k <br /> Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NS)AND INDICATE m <br /> NORTH(N). C n <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 v <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO 0 <br /> BUILDINGS,ROADS,LAKE,LOT LINES. <br /> ld� <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <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. 0 c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SCAN ONSITE VERIFICATION MAYBE DONE WHENNEEDED. <br /> Cr <br /> o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: Z0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. ) <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. O , <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY N i <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. m I <br /> �C CL m <br /> CL <br /> 7. '" 003 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my m <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 recognize 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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> m i <br /> SIGN HERE � <br /> (signature o owner or building con actor) (date) <br /> ZONING ADMINISTRATOR <br /> .UITOWNSHIP PERMITS MAY BE REQUIRED gg g o <br /> 4 <br />