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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 /> y O <br /> c C' <br /> OWNER TELEPHONEL-�hLed� <br /> 9g?-NO ) <br /> m <br /> p /1 / <br /> HOME ADDRESS ! O S a��fi 5�_ I� 1 J o55 e * 0,5 _ <br /> EMERGENCY/FIRE NUMBER a ` �617 ROAD NAME & W. 1 <br /> LEGAL DESCRIPTION(see tax receipt) /d _ $ 70^� coo C <br /> Ufa esm dol , oil G y Y <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUC URE ❑ ADDITION ❑ PRIVY ❑ C 0 <br /> TYPE OF PERMIT(S): p� or <br /> FILLING/GRADING ❑ CAMPING UNIT SUBDIVI ION ❑ 5. 4� <br /> L/////lji HGf� — o <br /> STRUCTURE/ADDITION USE: � <br /> c J ome/Cabin; Commercial Business; Bedroom; Deck;etc.) U <br /> BUILDING CONTRACTOR: <br /> m <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. 0 y o <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o C <br /> 'f1 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m n <br /> NORTH(N). ca C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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. N e <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO V (� <br /> BUILDINGS,ROADS,LAKE,LOT LINES. 9v <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 I <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: W <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT SU <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 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. O A.- E//Ye / tU76d^- -to S,d e ( &,d) � i <br /> z =. 0 ; o L <br /> 6. Su6�-1- 8K'-1k� Yaw r�c1a �� ,��,� (0 C 1 5. Z <br /> 7. o N =M o f <br /> cn <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my i3 c c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize d m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ; 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 <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 th above described premises at any reasonable time for the purpose of inspection. <br /> CD <br /> m : <br /> SIGN HERE d <br /> (sl lure of own building contractor) (date) <br /> ZONING �ADMINISTRATOR <br /> 1�� <br /> Na <br /> N Nf7� <br /> (T fT O O <br /> O O O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 <br />