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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -U a <br /> APPLICATION FOR LAND USE PERMITS31 <br /> 3. <br /> r <br /> c ° <br /> OWNER U F )B <C TELEPHONE b S/ - 4ig <br /> HOME ADDRESS 3&!� S� R l�7 DA 1 L 'S r C 1 <br /> r m <br /> EMERGENCY/FIRE NUMBER <br /> ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) Aj C � <br /> J 77 •�j � <br /> n <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ ) Cl) o <br /> TYPE OF PERMIT(S): � 0 <br /> c <br /> FILLING/GRADING (�PING U I ❑ SUBDIVISION ❑O a <br /> STRUCTURE/ADDITION USE: '—" <br /> o. <br /> (Home/Cabin, Commercial Business; Bedroom;Deck; etc.) y <br /> m <br /> BUILDING CONTRACTOR: 5 A/ t K ln4 A) 4 U M A� R <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 ` <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 'n 3. <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING• (AERIAL OR TOP VIEW) � <br /> O a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. nZ <br /> 0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). a 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO CO) v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Z <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, 100 <br /> ETC.,THE PLANS N <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o � ( <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. Cr ° <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z _ w <br /> CONDITIONS OF PERMIT: P <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 I I^ <br /> PERMITTED. V 1 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. ryLet& jy- , }'C CAS Q,U �C-Q7L�O_WC%W <br /> M . m m m <br /> CD CL CD <br /> 6. v m C w ° 3 <br /> 7. Z mw ° <br /> —m: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m � C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m ;U <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- p <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 y <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized pe on to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> SIGN HERE ( )=—L/ �+ d' E '• <br /> ( n r,of owner or bulldigo c ntractor) (date) .0 <br /> ZONING ADMINISTRATOR vE <br /> 4Qfn fn N fn <br /> "(ll f!1 (rl O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 o 0 0 <br />