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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 0Z <br /> APPLICATION FOR LAND USE PERMITS 3 4 ° <br /> N 0 <br /> � <br /> OWNER ��yL ` /✓ TELEPHONE I,11Z <br /> 6 m <br /> HOME ADDRESSHR7 ��� STQic,•-c/LN..�, v <br /> EMERGENCY/FIRE NUMBER yy ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) Pr 1. L L3 Csh-) V j �/�1 a] I CA <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRRIW ❑ ,� o <br /> TYPE OF PERMIT(S): C y <br /> Cr <br /> FILLING/G ING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: — �� f ( �— yL�L( `— h o <br /> �J <br /> (Home/ abin; ommercial Business; Bedroom; Deck;etc.) - <br /> BUILDING CONTRACTOR: R m <br /> 13 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X I1 SHEET OF PAPER. ANY INCOMPLETE OR3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n 3 <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Z� <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). C ()I n <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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. V` o <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. <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. W o O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN p G <br /> NEEDED. OO T^ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z o <br /> CONDITIONS OF PERMIT: 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT b �•`'� <br /> ISSUANCE. �\ W <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. p <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY U <br /> PERMITTED. I� <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. ;aM00Qpa L m�� <br /> � N C N N > > i <br /> 7. Z : N N f 0 1 <br /> O <br /> y: 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 ofm C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CD m <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above de cribed premises at any reasonable time for the purpose of inspection. <br /> CD <br /> m : <br /> SIGN HERE <br /> (s n of owner or buil ontractor) (date) <br /> ZONING ADMINISTRATOR <br /> cn wfnwwln� <br /> N NIT NN NIT <br /> IT IT O Ill Ill O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />