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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v G Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> 0 <br /> �, o <br /> m <br /> n •` <br /> OWNER /� %�G TELEPHONE <br /> HOME ADDRESS <br /> 1032 As co hur- Se_ Ame,?4 w, <br /> EMERGENCY/FIRE NUMBER 9dp Sf ROAD NAME 191q f-f 1-4& t <br /> 1 <br /> LEGAL DESCRIPTION(see tax receipt) SECT/off' /7 /,,vP, �p lQ, /�1 �c`t,. .✓E A)e- <br /> TYPE OF PERMIT(S): �} <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY cn 0 <br /> `v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: eA13111r <br /> (Home/Cabin; Commer ' I Business; Bedroom; Deck;etc.) rn <br /> m <br /> BUILDING CONTRACTOR: L` Co.J.TcsFcTF-3 <br /> o� <br /> T <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> Ay C i <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> T o. <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 5 m X <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 9 <br /> NORTH(N). C <br /> rn <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. <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 LED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,C C.,THE PLANS o <br /> MUST BE SIGNED AND DATED BY THE OWNER. ' •j./(J�1o <br /> D <br /> J l <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFI TION MAY B,JM�Z/ = °, <br /> NEEDED. ��/ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: Q�R/�F % P <br /> 1 SSVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 20/ QAC IJ/V <br /> UANCE. ,Y <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. I <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 ASA. <br /> 5. /, �1 r <br /> M m v n M n f m <br /> 6. CD 3 a Co 0 CD <br /> N C N y O <br /> y 0 O O <br /> 7. <br /> — U) A <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 I am responsible for the detail and accuracy of a <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize PP ( 9 Y ) 9 ° p <br /> m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is RR � R, <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 r�J <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. fD <br /> m : <br /> CD <br /> CD <br /> SIGN HERE � G <br /> (signature wner or building contra ) (date) <br /> ZONING ADMINISTRATOR Air <br /> 1 '110 -T WNS IP PERMITS MAY BE REQUIRED <br />