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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> fn O <br /> OWNER �(l1�nl� N�iur1E' TELEPHONE _7 <br /> (0�� �i'y,Gy93 <br /> HOMEADDRESS 5a� Su nn( d� Qd rncu�dSy,Pk1 i'h/) 55�t a - v <br /> EMERGENCY/FIRE NUMBER y a5 ROAD NAME /Yli n[ 40 tjKt <br /> 1 <br /> LEGAL DESCRIPTION(see tax receipt) o <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTUREX ADDITION ❑ PRIVY ❑ c <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION5, <br /> eCt� +W O 0-f� a-F d I P Pc r n <br /> STRUCTURE/ADDITION USE: � <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: �� L� ���� " <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR In 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) ii <br /> O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m v <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C <br /> NORTH(N). CO) <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 Z <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 /> S. 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 2, <br /> MUST BE SIGNED AND DATED BY THE OWNER. v 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN a ° G <br /> NEEDED. ^' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o ,' <br /> CONDITIONS OF PERMIT: _ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT \ <br /> ISSUANCE. J <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. m M 0) M O m <br /> r. <br /> 6. v� mcm !" o � 3 <br /> Nm ° °f° -1 <br /> 7. <br /> x <br /> = 0n : i m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G)c c <br /> m <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize : m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- l7 <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 /> -n <br /> m <br /> SIGN HERE <br /> -11 -00 <br /> (signatu eo er or uilding contr for (date) <br /> ZONING ADMINISTRATOR `�/�—jtdr y"dr w cn cn c <br /> N N(T N Nt7TUPI <br /> 0-? <br /> � �� <br /> T NSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 <br /> 0000000 <br />