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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office oning Administrator v Z <br /> APPLICATION FOR LAND USE PER ITS o <br /> r rX+ <br /> N <br /> OWNER TELEPHONE o e <br /> / �S/ ys�I s�y8� _ <br /> HOME ADDRESS 3��/`�l f P / N r� t O <br /> 3 / r m <br /> EMERGENCY/FIRE NUMBER ROAD NAME /�I <br /> LEGAL DESCRIPTION (see tax receipt) A �J D _& vI v � cn <br /> DWELLING/BUILDING ® GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ Cn o' <br /> TYPE OF PERMIT(S): � � <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ _n <br /> y� J� U) <br /> STRUCTURE/ADDITION USE: � � /,� / y1 — /'wwr-w o' rT,'1 lJJ <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) Cn ll O <br /> BUILDING CONTRACTOR: C �(,t t x <br /> m <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 <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O CD <br /> -n o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n ? <br /> n o Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m ED <br /> NORTH(N). C 0 <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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. / o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO lJJ <br /> BUILDINGS,ROADS,LAKE,LOT LINES. G <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS qj <br /> 0I <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> f <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: ° <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. co <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY W <br /> PERMITTED. ID <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATE <br /> SETBACK AREA. '/j/ �� <br /> 5. / / ��� � f./�/ / QC/tfY/w, <br /> /1/,/1 /`� 'l c�l �, ; -0 y ari > 0 a a m <br /> 6. Ute[ m 3 nm O� n (D .-a <br /> CD y O 3 <br /> 7. Z y N O f0 <br /> m <br /> - cn A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Gj c C <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of a <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m C m <br /> CD <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 <br /> m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person ave acces he above described premises at any reasonable time for the purpose of inspection. fD <br /> m <br /> SIGN HERE <br /> a , <br /> (signature of owner or bkilding contractor) ( ate) <br /> ZONING ADMINISTRATOR a d <br /> TOWNSHIP PERMITS M Y BE REQUIRED <br /> d <br />