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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o � <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> y O <br /> UI <br /> -7x- <br /> OWNER '-'i".� p0; tT- LLA, , TELEPHONE �0 <br /> 73 <br /> / t <br /> Nc <br /> HOME ADDRESS 3 3 U <br /> Z <br /> EMERGENCY/FIRE NUMBERI RSOA7A�M� <br /> m <br /> /I <br /> LEGAL DESCRIPTION(see tax receipt) M p ,e t/ <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE 1:1 ADDITION El PRIVY ❑ ° <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> � ( / 4J <br /> STRUCTURE/ADDITION USE: C YC h V- /fid b/J <br /> [[[ (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) CA ` <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER.ANY INCOMPLETE R IVIJT 1 3 W <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. }\ -n�- I 1 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) , � CJn "gym' 10)5 ®r O m <br /> /� �e�3-23f o i/Ylr lu�Idta a Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN SCAL ►YIOI,c— IU��bAt;�t�o m z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m fD VV <br /> NORTH(N). y I 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <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. N oA <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS pb=. <br /> MUST BE SIGNED AND DATED BY THE OWNER. 1 Cos o W <br /> v � W <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN r B L� <br /> NEEDED. \ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. 1 <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. v <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 0 T 0r- O Om <br /> �' � 3amx�- .'0 <br /> 6' a : 0 <br /> Z <br /> 7. o .0 <br /> =y : 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 c iZ <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize M m <br /> PP f 9 Y ) 9 I m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m l7 <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I amm <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other to <br /> authorized person to access to the above described premises at any reasonable time for the purpose of inspection. ,n <br /> CD <br /> L m <br /> SIGN HERE <br /> (signature of wne or building r) (date) <br /> ZONING ADMINISTRATOR <br /> r�Rool N N N f 11 NOWNSHIP PERMITS MAY BE REQUIRED0 0 0 0 0 0000000 <br />