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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> CD <br /> f/ <br /> OWNER C{Z R TELEPHONE o <br /> HOME ADDRESS,�_) 77,2 �?n� N I <br /> l( GPS- h1�,bs- - ham-- 0 <br /> EMERGENCY/FIRE NUMBER San-'P_' ROAD NAME �~ <br /> LEGAL DESCRIPTION(see tax receipt ��/ �lj `�� I�G /�. <br /> / CD <br /> nn�A 0 <br /> CJ N <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE-4-C—ADDITION <br /> Q <br /> S. <br /> S. <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> co <br /> STRUCTURE/ADDITION USE:,��`V�� V u 5�' �l �Jy�D�sL I �j X ;)42 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) � <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. In _- <br /> x <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. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> 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 LAKE, Z <br /> STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- <br /> INGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N CD <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS 0 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o o <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q <br /> ISSUED. o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z j <br /> CONDITIONS OF PERMIT: P 1�5 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT i <br /> 11) <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. \J <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> prolvvo <br /> 5. <br /> 6. it J VCi \✓lam v " ` "� i ��jj `--ALJ' i V - CD n r' O Da O IV� m . m e m <br /> E m c H " o > 3 <br /> 7. �a �1� �� i 7s�� r)eu> 2r� Z "� <br /> ' �: z <br /> I declare that this a lication mcludin an accompanyingschedule has been examined b me and to the best of m m <br /> PP 9 Y ) Y Y G7 O <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of �6. n c C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m M <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 Coun formation I am <br /> providing in this application. I agree to permit county officials charged i is o ces or other m <br /> authorized person to have access to the above described premises at any 11 r inspection. m <br /> ' m <br /> SIGN HERE JUN r <br /> (sig tore of owner oruilding contractor) (dat i <br /> ZONING ADMINISTRATOR ' . . . . . <br /> fA vi ei FA cA to <br /> ZONING NNNN(TU <br /> � o �� oo <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />