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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 /> r <br /> N O <br /> N <br /> C <br /> OWNER C K TELEPHONE — SS o <br /> m <br /> CD <br /> HOME ADDRESS S /Y► S T s'T n v L !✓ V <br /> 0 m <br /> 0 <br /> EMERGENCY/FIRE NUMBER S ROAD NAME �/�'��.. �q /2� p / I <br /> qj <br /> LEGAL DESCRIPTIONt see tax recei rn <br /> ( p) vT .S o2la 5� N�'%Sc v Taw,v of sw s;rCD <br /> DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ ) N <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> N <br /> STRUCTURE/ADDITION USE: � /V/ <br /> Home/Cabin; Commercial Business; Bedroom; Deck; etc.) to <br /> J m <br /> BUILDING CONTRACTOR: ©/1 L, ' m ]� <br /> m <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/a X 11 SHEET OF PAPER. ANY INCOMPLETE OR B C <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED T <br /> X m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTAN ES TO BE SHOWN OR DRAWN TO SCALE. m m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATEAa <br /> NORTH(N). y <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) EASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <br /> LAKE,STREAM OR RIVER AND MEASUR MENT TO WETLAND AREAS. ` 9 <br /> 4. SHOW THE LOCATION OF THE WELL(W) SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO O <br /> BUILDINGS,ROADS,LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS I ILANNED AND SHOW AREAS TO BE GRADED OR FILLED. 1 I <br /> 6. IF SEPARATE PLANS ARE SUBMITTED B AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0 ()� <br /> MUST BE SIGNED AND DATED BY THE 01 VNER. o 1 <br /> O 0 <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS 9UST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 0 1 <br /> CONDITIONS OF PERMIT: <br /> 1 <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. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAININGWALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 6. <br /> m N m x °' <br /> 6. `�^ /�/ 3 n m <br /> mcy `" o = <br /> N N O : = t0 <br /> 7. O zil'. �I <br /> — cn : M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my (r G _ c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of IIJIJ Q ^ A <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 'D 0 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- a C) <br /> sue a permit. I further accept all liability which may be a result of the Cq f on this information I am m <br /> providing in this application. I agree to permit county officials charged'' un ty ordinances or other <br /> authorized person to have access to the above described remises at an eea t e purpose of inspection. m <br /> P P p p P T : <br /> CD <br /> SIGN HERE 6 LIIULY —�� <br /> (signature of owner or§PAdMg contractor) (date) <br /> ZONING ADMINISTRATOR Tim F - <br /> eQ'NiNG <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />