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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - c�\1` o <br /> APPLICATION FOR LAND USE PERMITS 3. An <br /> y O <br /> y <br /> ` n <br /> OWNERpa TELEPHONE o <br /> _j� ( Al <br /> d <br /> HOME ADDRESS /I 7 `_[ ch r�j� <br /> r <br /> o <br /> EMERGENC /FIRE NUMBER ROAD NAME <br /> e;a ill Arr <br /> PCA Iv`la. gksW i9-yo-/7�^ aov ° uU —G l <br /> P <br /> LEGAL DESCRIP (see tax receipt) 30-q -� S /U� j \ 1/ cn <br /> CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ (% <br /> TYPE OF PERMIT(S): Cr = i <br /> FILLING/GRADING CAMPING UNIT SUBDIVISION nY <br /> N Y <br /> STRUCTURE/ADDITION USE: ' ( LCl ((ti/G a 0 (1 „ <br /> (Home/Cabin; Commercial Business; Bedroom; eck;etc.) U) �U <br /> y <br /> BUILDING CONTRACTOR: ukau"'.- <br /> �2 <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. p " C� <br /> C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O _n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m Ln � <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 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF J Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. a <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO Ca O <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 0. ) <br /> MUST BE SIGNED AND DATED BY THE OWNER. Od <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. 2 t O O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 0 1 <br /> CONDITIONS OF PERMIT: U./ I <br /> O � L <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Q <br /> C <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY `O <br /> PERMITTED. C iLJ <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER (/y <br /> SETBACK AREA. folu p <br /> 5. <br /> � v � <br /> �'r > 0 a 0 T <br /> �m <br /> 6. m B aCD W <br /> m a _ <br /> y y O <br /> D O <br /> 7. O -n ZI <br /> - � : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a a 0 p <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize PP ( 9 Y ) 9 ° p <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> 0 : <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 <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 described premises at any reasonable time for the purpose of inspection. -n <br /> m : <br /> ID <br /> 69 <br /> SIGN HERE <br /> (signature of owner bullding contractor) / (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />