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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 /> r <br /> " 0 w <br /> N <br /> C <br /> OWNER 11 TELEPHONE 7 S_ J�l7 Q 7 <br /> CL <br /> �]Q. C1C7�v� Snv� 71 s�— <br /> m <br /> O <br /> HOMEADDRESS 1a3gr) J�j. C-ra. r-le)Snrl kik RA . <br /> r � <br /> EMERGENCY/FIRE NUMBER � e _ ROAD NAME <br /> i2Isnyl <br /> LEGAL DESCRIPTION(see tax receipt) SPC•3u2 <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ElADDITION ❑ PRIVY ❑ nt Cl) ° <br /> TYPE OF PERMIT(S): VV Cr <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION El 5. <br /> °` ' <br /> N <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) rn <br /> W2. <br /> P <br /> BUILDING CONTRACTOR: ' d e.S rsh,she rmZs- <br /> l.s <br /> A PLOT PLAN MUST BE PRONDEDbN AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 9 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> .ZI y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 0 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. A <br /> 2 .SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m n <br /> NORTH(N). W ° <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 I Z <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 'C <br /> BUILDINGS, ROADS,LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ii <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS CRl <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> to <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHENI <br /> cr <br /> NEEDED. /„ t� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. W o W� <br /> CONDITIONS OF PERMIT: 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Q CIS <br /> ISSUANCE. ) O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. I" <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SE BACK AREA. <br /> 5. yz-af �O cAo � md �+' CCD Fm <br /> 6. \ vninNLcd � <br /> -a : m Cis 9 3 <br /> �r�Qss° - Z : : ° i <br /> 7. o y: z <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of n 0 <br /> all information contained in this application(including any accompanying schedule)and 1 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- <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 CO <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> co <br /> CD : <br /> SIGN HERE <br /> (sign re o er or o r tar) (date) <br /> ZONING ADMINISTRATOR <br /> N N (INNNfT <br /> °t (lO Cn V1 O O <br /> T NSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br /> 0000000 <br />