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Burnett Co inty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 Q� <br /> N � r�— <br /> N 111(D <br /> OWNER '�Dn r 1 n �i -ci('SO TELEPHONE f/_O — 7 /1/ n <br /> o <br /> / m <br /> HOME ADDRESS n71 n aJ� <br /> 0 <br /> EMERGENCY/FIRE NUMBER 3V�� ROADDjNA/M'E// <br /> LEGAL DESCRIPTION(see tax receipt) �C� � �Q J �0��({Y 1 <br /> DWELLING/BUILDING 1:1GARAGE/ACCESSORY STRUCTURE I,QJ ///ADDITION ❑ PRIVY ❑ V> <br /> TYPE OF PERMIT(S): \ Q <br /> FILLING/GRADING CAMPING UNIT 11 SUBDIVISION ❑ n <br /> ? y <br /> STRUCTURE/ADDITION USE: I�I IQ-I 1 � Q X3lJ1 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) U <br /> BUILDING CONTRACTOR: CD <br /> m <br /> CD <br /> I <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 0 <br /> T 0 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE CD <br /> C o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 9 <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. 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 /> 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 Sb <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 <br /> O � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. 0 ) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: tz � <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. <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 /> SETBACK AREA. <br /> 5. <br /> ( 'Ud °r' 0 ° a ° m <br /> 7. //�1�� / / C ✓ Thr n��CJ l�ic��/ E L 0 -ny N m <br /> lJ�-'i l-C.11-(.J"ei 1� !Cll / 1 Z m � o i0 3 <br /> �� : <br /> 1 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 o <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize PP (� 9 Y ) 9 `Dmf p <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 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 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 described premises at any reasonable time for the purpose of inspection. T <br /> CD <br /> CD <br /> SIGN HERE �� <br /> (signature of o ner or bui ding contractor) (date) <br /> ZONING ADMINISTRATOR �:rm C7T 1 G� <br /> a <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />