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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N <br /> OWNER " TELEPHONE <br /> `p <br /> HOME ADDRESS O <br /> s' /` CL Wp�S�� J S[1 01M <br /> �? f <br /> r CD <br /> �^ 0 <br /> EMERGENCY/FIRE NUMBER AppII Q d r7(y BRAD NAME �I P�z <br /> � I <br /> N1?w C s rn e crnin5 " lea`t t of o ��6ert- Ku l6 car Sccd �j, re <br /> LEGAL DESCRIPTION(see tax receipt) � G„ L l �q- ,IL) <br /> DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY o' <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 4 <br /> rI �, LL ��p � I, ��J� w <br /> STRUCTURE/ADDITION USE: NO rn e- W' AA- �� T LQcV— <br /> (Home/C/abibin; Comm�Jercial usiness; droom; beck;etc.) re <br /> BUILDING CONTRACTOR: <br /> C <br /> CD <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. TO y ry C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n (`• <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). Cn o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 1_ 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OFIf> <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ('�, 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 /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 'Ski h <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONT7kgTOR, ETC.,THE PLANS &U <br /> MUST BE SIGNED AND DATED BY THE OWNER. / <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFIC TIO E o O <br /> NEEDED. I <br /> Me Z C!) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. �/T o r'I p <br /> CONDITIONS OF PERMIT: �' .y ? / z v <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z® <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. N(�VN�. L` <br /> A ^/ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. �, b <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER (� <br /> SETBACK AREA. <br /> 5. Xv0v > oaov <br /> 6. m � 3 ac nc <br /> -o cDcN !" 6 <br /> 7. 0 ID _ � A <br /> - m . AI declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> CD m <br /> M <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize CD <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> G) : <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 <br /> authorized person to have access to the above desqjjbed premises t any reasonable time for the purpose of inspection. fD <br /> -n <br /> (D <br /> / ,+yt� (D <br /> SIGN HERE L 2 ��(� 69 <br /> (sign lur7of w r orn c / (dat <br /> ZONING ADMINISTRATOR / Z� <br /> q C <br /> T NSHIP PERMITS MAY BE REQUIRED <br /> l O <br />