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Office of Zoning Administrator Q o <br /> Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 3 <br /> APPLICATION FOR LAND USE PER y 0 <br /> Q n <br /> (� TELEPHONE Z S9 ^7 31 7 <br /> OWNER �pj fLL P la l L.� ? p <br /> 54 a � <br /> HOME ADDRESS 3p 18 I �� �G�R DR bArti�y�'"t , r- CD <br /> Ir <br /> EMERGENCY/FIRE NUMBER <br /> ROAD NAME ( O IV:—AS N AD <br /> eZ sa�,;-'y r, <br /> l7 ) m <br /> LEGAL DESCRIPTION(see tax receipt) rd e <br /> o <br /> ADUITION 19 PRIVY ❑ Cf)c <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE [Ic <br /> TYPE OF PERMIT(S): 5. <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ yo' <br /> pb rLc� <br /> y <br /> STRUCTURE/ADDITION USE: m <br /> (Home/Cabin, Commercial Business, Bedroom Deck etc) � <br /> 1c <br /> BUILDING CONTRACTOR: U v <br /> m <br /> T 3. <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/n X 11 SHEET OF PAPER. ANY INCOMPLETE OR � C <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. XCDn <br /> DIRE TION FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) TZ <br /> n m <br /> m m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. c 0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> to 3 <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(R BUILDING(S)T <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF c <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 2. <br /> 0. '� <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLA 10 o g <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST WHEN <br /> NEEDED. Z <br /> o � <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. _ <br /> CONDITIONS OF PERMIT: <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 RETAINING WALLS,ETC.,ALLOWED WITHIN THE�REQUIRED <br /> T <br /> ER <br /> SETBACK AREA. '�i � I Cq + <br /> 5.�L ,C J v 41 e�N ri. = <br /> In 0 <br /> CFc-if an ch rn <br /> o 70 <br /> 7 ZS c <br /> lication (including an accompanying schedule) has been examined by me and to the best of my <br /> I declare that this app g y <br /> n : C <br /> e detail and <br /> curacy of <br /> knowledge and belief it is true,correctca=nod cincPudin anckaccolmpany ng schedule)and I furtheedge that I arn responsible for r declare that Icrecognize �. m :' mm <br /> Is- <br /> all information contained in this app g y m <br /> O <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> may be a result of the County of Burnett <br /> sue a permit. I further accept all liability which 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 the above described premises at any reasonable time for the purpose of inspection. <br /> 4 : <br /> SIGN HERE (date) <br /> (signature f owner or building c ntractor) <br /> • wwwwwtn� <br /> /��� N N N N N CA <br /> ZONING ADMINISTRATOR o, v,P o v,v, 0 P 0 <br /> 0000000 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />