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Burnett County 7410 Co. Rd.K,No. '102, Siren,W164872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> OWNER OI-IN61FPHONE 7)cS-347 da <br /> p, Y /y /�IYJ^A' 0 w <br /> HOME ADDRESS 3192 W-e-S'TrP('P (BL t/D > / V v/u 0 Ml N lJ 3 .S3 fo y v 9 <br /> 0 <br /> 0 <br /> EMERGENCY/FIRE NUMBER y gJ Q0 W S ADO I 9T ROAD NAME &ILT/r " (/ 1); <br /> I <br /> LEGAL DESCRIPTION(see tax receipt) ' 0 <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION)9 PRIVY ❑ ) <br /> TYPE OF PERMIT(S): t (��or o <br /> FILLING/GRADING ❑ CAMPI G UNIT El SUBDIVISION El <br /> STRUCTURE/ADDITION USE: CA I�I //v IN G 00 0 <br /> (Home/Cabin; Commercial Business; Bedroom;Deck; etc.) rn <br /> BUILDING CONTRACTOR: !Se-LF- <br /> A <br /> SeLF-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. 0 - <br /> N W <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) m <br /> n o. <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE �? <br /> NORTH(N). p o <br /> 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m [f� 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF I13 <br /> 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. o ) <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Cr <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> 0 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT + 721) <br /> ,, <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <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. / <br /> 5. lFAGC�f/o,. trus4-J-w- A-f le-a-bf" �SF-t- F:-vsn PLrjl�G.eAI1)R �F/J�kB xv0r- o o -0 <br /> 6. (J U ON S ye �W ICY .�j FYa m <br /> � m7. <br /> o : <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 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 an accompanyingschedule and I further declare that I recognize � D <br /> PP (' 9 Y ) 9 <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determini�'g,9gwhether to is- O <br /> sue a permit. I further accept all liability which may be a result of the County of Bu r hic7lomtation I am m <br /> providing in this application. 1 agree to permit county officials charged fr i�iisFgrir�g P ► cbs or other m E <br /> authorized person to have acces o t bove described premises at any on .A p e in e 1 spection. <br /> CD <br /> Ic or, <br /> SIGN HERE I� 'I((,� � • <br /> (sig of o er r building contractor) AU`- (date) <br /> ZONING ADMINISTRATOR <br /> to to to to to w <br /> ZoNmGN N N N Ut o <br /> {y 9`� <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 <br /> 0000000 <br />