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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administr 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> U o <br /> N <br /> CD <br /> OWNER (Z f fig(. TELEPHONE t.51-06 ^3-7 43 v <br /> HOME ADDRESS 3b 50 W A-&1t <br /> r � <br /> 1 0 <br /> EMERGENCY/FIRE NUMBER Q 4 L� ROAD NAME MOM^ LA-KL D21 U 9 <br /> G � � 1 <br /> LEGAL DESCRIPTION (see tax receipt) ��S ��0 21 TOwNSNi�3 8N Rzb �('IW �ANrCLS of CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION PRIVY ❑ o <br /> TYPE OF PERMIT(S): i <br /> FILLING/GRADING ❑ CAMPING <br /> �UNIT <br /> /❑ SUBDIVISION ❑ �. <br /> STRUCTURE/ADDITION USE: CAel N IDRtPF = <br /> - <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) m <br /> BUILDING CONTRACTOR: �iT>rit) Si�if-�62tI�dL <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 = <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n <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 /> C <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 Z <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 SQ <br /> BUILDINGS,ROADS,LAKE, LOT LINES. :E <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> o <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. <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o p <br /> CONDITIONS OF PERMIT: �J <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. 1 <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 WATER C� <br /> SETBACK AREA. <br /> �' C <br /> 5. <br /> CD w d 0 m a £ m <br /> 6. .o o� <br /> Z N CD y O <br /> 7. o -n� <br /> cn m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) C <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of o 0 <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize ` <br /> P (� 9 Y ) g `� m p <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 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 other o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. -n m <br /> m <br /> m : <br /> SIGN HERE <br /> (signature of o r or b lldi g contractor) (date) <br /> ZONING ADMINISTRATOR 1 i <br /> TOWNSHIP P RMITS MAY BE REQUIRED <br />