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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> OWNER awe 1 � �}/P/I� TOt{rS TELEPHONE 2ff 3d7- 83 Y7 p .� <br /> m I ^ <br /> HOME ADDRESS / 7D 3D ("_ <br /> r m <br /> ed <br /> EMERGENCY/FIRE NUMBER I t�ROAD NAME �-Y ( \ <br /> /e e a / god 600 o,/ �5 <br /> LEGAL DESCRIPTION (see tax receipt) iltf Q?P 7�(e /Z/4�7 �� fCs7 3 "r'Af' 3� /rye � m <br /> r c� <br /> O <br /> DWELLING/BUILDING V GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ Co./A �-c <br /> TYPE OF PERMIT(S): t✓ n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <: <br /> N <br /> STRUCTURE/ADDITION USE: �G <br /> `(Home/Cabin; Commercial Business; edroom; Deck;etc.) <br /> BUILDING CONTRACTOR: �/lP <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n n <br /> Z! o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE mo <br /> NORTH(N). 2 <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 o <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. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0. <br /> MUST BE SIGNED AND DATED BY THE OWNER. ° <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN ° I <br /> NEEDED. (� <br /> z _ i <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. 4�,, ( ; 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ` W <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY O <br /> PERMITTED. N <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. ( C) � ODaoM <br /> DCL <br /> 3 n m % �-m <br /> Z o 1 <br /> 7. o 21 RAI <br /> _ � : p <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 0 2 c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of a 0 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m mo <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- n�J <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 application. I agree to permit county officials charged with administering county ordinances or otherCD <br /> m <br /> authorized person to have access to the ab scribed premises at any reasonable time for the purpose of inspection. T <br /> GCD : <br /> SIGN HERE <br /> (sign tur of owner or building contr for (date) <br /> ZONING ADMINISTRATOR Ct <br /> Cb <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />