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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N O <br /> f/1 <br /> CD <br /> C <br /> OWNER J:31� TELEPHONE a /n <br /> HOME A ESS 1A,0171 <br /> t Lti ✓ l O <br /> S Q c <br /> EMERGENCY/FIRE NUMBER /�D / ROAD NAME ~ <br /> LEGAL DESCRIPTION(see tax receipt) Cn <br /> -3 7CD <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ rn oma' <br /> TYPE OF PERMIT(S): a3 <br /> or <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5 <br /> STRUCTURE/ADDITION USE: aamt d 1 EUi►f3, �1C4 ��(fE(JWt �1�Nt�• 0 <br /> (Home/Cabin; Commercial Busines ; Bedroom; Deck;etc.) in <br /> BUILDING CONTRACTOR: fi fj%j�jr� �it,�t�/�,QI�/fes /j�/(� 9 \ <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. I <br /> -0 c <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) 0in n <br /> In Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m :° <br /> NORTH(N). <br /> 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 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. � 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. d <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I 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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN �lJ , <br /> NEEDED. 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P I <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Q� <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. y <br /> 5. exIS�7/► ({f�lASe (�.I/ 1012e�1 y� bTC�M 74 A— Off' IVP,�'� �'� SA.v� �0 <br /> /dJ r <br /> m = o0id McL9m <br /> 121 <br /> 6. S( r, / rf f�7�S n.�(n � t IS S/V/I{bi/r{ici 3 n 1Wa 70 <br /> 7. Z • <br /> o : <br /> =y : <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c ID <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m 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 <br /> providing In this application. I agree to permit county officials charged with administering county ordinances:or other m <br /> authorized person have access to the above described premises at any reasonable time for the purpose of inspection. T <br /> co <br /> SIGN HER �I <br /> (sign ure of owner o uil In contractor) (date) �< <br /> ZONING ADMINISTRATOR ' <br /> • Fn fn v+v+v+ <br /> N N U 1 N N p, v, o u, In o <br /> N <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 0000000 <br /> 0000000 <br /> I���� �/ <br />