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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 4 P <br /> ^_ rFN T <br /> t <br /> C <br /> OWNER s g l t i ` f>PK� TELEPHONE o <br /> HOME ADDRESS O <br /> y� Q <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) LIIQ��II� 2 �S� I, i •s Iry���Is -o _/ 1 5 ( 0 <br /> DWELLING/BUILDING IBJ GARAGE/ACCESSORY STRUCTURE IC.`J ADDITION ❑ PRIVY E y o <br /> TYPE OF PERMIT(S): (( C <br /> FILLING/GRADING ❑ CAMPING UNITE] SUBDIVISION ❑ a <br /> S. <br /> STRUCTURE/ADDITION USE: F N <br /> C �JZC�'GZSI,C_ o' <br /> (Home/Cabin; Commercial Busin s; Bedroom; Deck;etc.) m <br /> I !! m <br /> BUILDING CONTRACTOR: LUG ow <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR Q 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m 3 <br /> O m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p <br /> n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Z <br /> -n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). C n <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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ll� I 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. (� N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS l 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. V o <br /> W <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. Cr <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z O <br /> CONDITIONS OF PERMIT: t <br /> Q <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. W LA 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. (� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY v 1 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. �ak�7CC ti<J C v O r o O m <br /> 6. V!r '� Gl rv1 IJI m m m m m <br /> 3 n a <br /> O iG <br /> =y: <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my pm <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m t= <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 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 1 am <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 dg3cribed prerolses at any reasonable time for the purpose of inspection. <br /> SIGN HERE ^ —2 44 : <br /> (signature of oiiner or b ding contractor) (d te) <br /> o v <br /> ZONING ADMINISTRATOR <br /> fn<n w <br /> N N (ll N N <br /> TOWNSHIP PERMITS MAY BE REQUIRED D00 . 0 Oki, <br />