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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -CD o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> _ r <br /> y O <br /> Ul <br /> C <br /> N <br /> OWNER 190CDIPES C1?AAj9,4 TELEPH1ON{E 3y9 a7" 2 p <br /> HOME ADDRESS G 3�Y M p 70 .LSD S� CPA) IJV d � s4s� v <br /> EMERGENCY/FIRE NUMBER s = ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) a ( La m <br /> n <br /> DWELLING/BUILDING ElGARAGE/ACCESSORY STRUCTURE ADDITION 1:1 PRIVY EIQ o <br /> TYPE OF PERMIT(S): ' <br /> c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ l /> <br /> y <br /> STRUCTURE/ADDITION USE: dd, d�r of llL c,-) <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) rn <br /> m <br /> BUILDING CONTRACTOR: A46VAIUS <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 61/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) / O o. !�Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCA[E/ m 0 —vim <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). CO) <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 V 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. <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. o <br /> 0 9 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q 0 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. }v� <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 <br /> SETBACK AREA. <br /> 5. <br /> ;a -0 0 r D 0 0 V <br /> On CL m <br /> 6. COD Cm y o 9 3 <br /> m <br /> 7. Z ' N � <br /> o � <br /> : <br /> =rn : <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m � <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CL m M <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. 1 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 charged with administering county ordinances or other fD <br /> to <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T <br /> m <br /> SIGN HERE _ <br /> (signature of ow r <br /> _§r.building contractor) (date) <br /> KA'9 <br /> ZONING ADMINISTRATOR I cn cn cn En to <br /> N (n N N N ul <br /> ut O 01 Ot 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />