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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - C o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> /...� Ce LL &I z -2bZ--0753 N <br /> OWNER Do" I Q �� F� N C" 1 TELEPHONE 76 3,J "2 E ( —6-70' n <br /> HOME ADDRESS '7 1 -:!� l /VO �� (.tJ C19 DR 0 <br /> EMERGENCY/FIRE NUMBER -S '9 3 !S; ROAD NAME F„WU LK <br /> I C> <br /> -S 1:- % Nom '/ Sec IS -rk/10LI1 RIs o <br /> LEGAL DESCRIPTION(see tax receipt) T`R� 8 I ur <br /> m <br /> DWELLING/BUILDING ;9GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY El �N� p <br /> TYPE OF PERMIT(S): Cr <br /> FILLINGIGRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 0- <br /> UJ/" <br /> t w� <br /> o . l3s�1T-SG DEC1� <br /> STRUCTURE/ADDITION USE: � � R ��� �' <br /> (\ ( ome/Cabin; Commercial Business; Bedroom; Deck;etc.) co <br /> BUILDING CONTRACTOR: D � r NC Iu <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 41– <br /> ;arn ` <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> -n z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n 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 /> v <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. I o <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. I <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o I <br /> _o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° <br /> q <br /> NEEDED. 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c (f� <br /> CONDITIONS OF PERMIT: (' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. �n <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY O <br /> PERMITTED. <br /> O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 6. and Reset loo' -5ethar f�s�Kes - W I <br /> 6. n end <br /> -Eu b� moved bacK sl( ► cam d� o?ducek co CL CD X y N 0 Mo 0 3 <br /> CW <br /> 7. <br /> I-- <br /> M <br /> I declare that this ap Ion (including any accompanying schedule) has been examined by me and to the best of my c i p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy ofC <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ;a <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> 13 <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 appli tion. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to a e access tot a above described premises at any reasonable ti w — -n <br /> ` CD <br /> m : <br /> SIGN HERE I <br /> ignature of owner or wilding contractor) (date) �1 <br /> ZONING ADMINISTRATOR I L004 <br /> stn w cn v+to f N Vt O N(TOTOWNSHIP PERMITS MAY BE REQUIRED BU�N�� COUNTY CZONING 0 0 00 0 0 .0 <br />