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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 PERMITS3. = Q <br /> _ r <br /> � n q •1 c O <br /> OWNER P W)Lr ( KI 1 S 6/V TELEPHONE 91,6— �43 S / n C> <br /> m <br /> HOME ADDRESS 63 7v DfUi L S <br /> r � <br /> A T 0 <br /> EMERGENCY/FIRE NUMBER 3 �Q ROAD NAMET)FJ rLs LA V--e-Ro Q Il ~ <br /> 1 <br /> LEGAL DESCRIPTION (see tax receipt) -& 4,)t S ic?-'a 2 4 3 CSM V 2 (3 <br /> DWELLING/BUILDING ElGARAGE/ACCESSORY STRUCTURE�ADDITION El PRIVY Elc <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRA ING PIN U T SUBDIVISION ❑ t ( 5 <br /> STRUCTURE/ADDITION USE: �� P f'I �� /` & o <br /> (Home/Cabin <br /> ; <br /> Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: /'l ✓L�!l It` 6{ <br /> M <br /> m <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. 0 <br /> i0 in <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> k' <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). Cc <br /> Cn 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. 9 <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. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o / <br /> o 0 . <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN (� <br /> Cr <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: c <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I 1 , <br /> ISSUANCE. I W <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. (� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFI <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHINy l <br /> SETBACK AREA. <br /> (;&#qcu <br /> 5. cc <br /> 6. SGP 0 ' 1�8 � 3 a ° - im <br /> ;a <br /> BURN 00 i <br /> N O ; O <br /> 7. ETT COU o : y ` € : € � <br /> 7n.... NTY v : —co : . : m <br /> I declare that this application (including any accompanying schedule) has been examine to the best of my Cr : : c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of n C) <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m mi 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 Co <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T E E <br /> r '' m <br /> SIGN HERE \� C�/� %' ' m <br /> (?� , E <br /> (signiture of owner or ulldin2 contractor) (date)afl► <br /> ZONING ADMINISTRATOR F <br /> N NtnNNtnN <br /> VI Vt O V1 Vt O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />