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942C4tr b <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Admiruistrator - o° o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> CD <br /> C <br /> OWNER TELEPHONE�1,41) 6 S46-ch <br /> 0 <br /> HOME ADDRESS�aip g�,4n Coa)-) f1��� �� 5s(133 v u' <br /> EMERGENCY/FIRE NUMBER 'l SIO / /I�I/rf�G(.l. L+�'/. ROAD NAME <br /> 17! <br /> LEGAL DESCRIPTION (see tax receipt)/01, y-,Se-C. Z y - TZ�In. /(, W ' u) <br /> m <br /> c <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE IM ADDITION El PRIVY ❑ <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ u <br /> S. <br /> La <br /> STRUCTURE/ADDITION USE: ,� <br /> 0 V (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) 01 Vl <br /> ((� <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/x X 11 SHEET OF PAPER. ANY INCOMPLETE OR CD3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> O <br /> �I in <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). N o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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. P <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. d <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. to o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> u, o <br /> NEEDED. r <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c 1 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> t <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING TAIN 'AAL LS, ETC, LL ED WITHIN THE REQUIRED WATER <br /> SETB K AREA. �/ gt� q <br /> 5. If (CD W = CD L m <br /> 7. d l�firo,(1 - sIa d (�e a'�ofa v�e%u. 9� . . . 3 <br /> Z : �^ N� 7o <br /> o <br /> / -y : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �j p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of d Et c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize F`y m CD <br /> — ;U <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. I further accept all liability which may be a result of the County of Burnett relying on this information I am m <br /> providing in this application. I agree to permit county officials char ordinances or other m <br /> authorized person to have access to the abov described premises a ona ,;;=tjpqse of inspection. T <br /> CD : <br /> CD E <br /> SIGN HERE <br /> ( i atur o riding contractor) Ott ( ate) <br /> ZONING ADMINISTRATOR <br /> ETT " ) En LLA <br /> COUNT/ N NPNNNP <br /> COUNTY TT (n (no (n (noo <br /> TOWNSHIP PERMITS MAY BE REQuT019 NG <br /> 0 0 0 0 0 0 0 <br />