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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v O Z <br /> APPLICATION FOR LAND USE PERMITS 3 P <br /> r <br /> N <br /> ZT <br /> C <br /> N <br /> OWNER06K ii ,[or-e-h-e Ora#'54�rk TELEPHONE 866 - ,8-<2r <br /> HOME ADDRESS �2�aYL W./aL�vc1 �►� ��aq �Jry , w, S��3o v <br /> EMERGENCY/FIRE NUMBER aga Y6 ROAD NAME W� wood �Av <br /> LEGAL DESCRIPTION(see tax receipt) Lot l0 S/-n V P/ 1)-*7 <br /> DWELLING/BUILDING <br /> ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ P- <br /> RIVY ❑ � ° <br /> TYPE OF PERMIT(S): <br /> o• 0 <br /> FILLING/GRADING El CAMPING UNIT ❑ SUBDIVISION ❑ om d <br /> 5 XS,v P CLp- <br /> N <br /> STRUCTURE/ADDITION USE: �.elt -% �' CjiJ <br /> (Home/Cabin; Commercial Business; Bedroom; �ecck;etc.) rn2. <br /> O <br /> BUILDING CONTRACTOR: O ISD Lvr 7— <br /> E <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/s X 17 SHEET OF PAPER. ANY INCOMPLETE OR T 3 C <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. _ p <br /> — z � <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 M ` O <br /> CL <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> ��rGL/Eyel� I O ` v <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NBYANGD�IN/DIICATE v <br /> NORTH(N). N O o <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 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. to o <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Cr <br /> W E (� <br /> NEEDED. a n -1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o loll i <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT R1 <br /> ISSUANCE. I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. W <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ^ <br /> PERMITTED. ID.� <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5, v l <br /> � vc>? <br /> 7. O : y <br /> M <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my O 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 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. 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 described premises at any reasonable time for the purpose of inspection. T <br /> M : <br /> CD <br /> SIGN HEREy 1 f <br /> (signane"M <br /> r or building contr r) ( te) <br /> ZONING ADMINISTRATOR <n <br /> tnwtntnEnv+� <br /> N NCn NNNCn <br /> V1 Vt O fT (n 0 0 <br /> TO NSHIP PERMITS MAY BE REQUIRED p11 0 0 0 0 0 0 0 <br />