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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> o <br /> yQQ <br /> C _ ` <br /> OWNER TELEPHONE -7 l5-IoS6 —`7'7 79 O Olt <br /> --A <br /> J^ n' nom, �,/ �,/q v O <br /> HOME ADDRESS 3 Q �iOl J=�CJ �f` �C%� .L1(,(1lEJ�uiY x{03 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME r,) <br /> LEGAL DESCRIPTION(see tax receipt) N� N t �VV �� ��kl V 1 <br /> 36�g1-7 v, <br /> t o <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ c <br /> TYPE OF PERMIT(S): rte( q ' ,1 <br /> FILLING/GRADING El CAMPING UNIT ❑ SUBDIVISION N. W <br /> / 0 <br /> STRUCTURE/ADDITION USE: ]ALL <br /> ' <br /> Home/Cabin; Commercial Busine , Be om; eck;etc.) d <br /> BUILDING CONTRACTOR: <br /> Q <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 G <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> :0 N <br /> C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> y G o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m _ v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF (-n\I <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 /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 0 5113 <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. fO <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN S <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. C <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> I <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER W <br /> SETBACK AREA. <br /> 5. m � oO+ ; � � mp <br /> m � 9aNmo� 3� <br /> 6. o c <br /> .. y <br /> COD � e1 <br /> oma : ,'pN <br /> 7. — m : [ m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 0 c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofCL <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize \ CD CD m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am00 <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. - <br /> CD : <br /> SIGN HERE (date)(signature of ner or building contractor) <br /> Fn <br /> ZONING ADMINISTRATOR d'd"^40 <br /> � �o� poa <br /> T NSHIP PERMITS MAY BE REQUIRED <br /> 0000000 <br />