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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator _ z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> _ r <br /> Vj O <br /> N <br /> C <br /> OWNER so <br /> ,�/�ber,'� &4,�2TELEPHONE j�=�3j- ( 3 0//l1777T"' m (� <br /> HOME ADDRESS <br /> r <br /> 0 <br /> EMERGENCY/FIRE NUMBER /2S43, ROAD NAME O�4e <br /> LEGAL DESCRIPTION(see tax receipt) Z 1f�-/t/-2�-0 40Y7 00/�L ` m <br /> 5C,23/_Z Va Sy �`� JCO <br /> DWELLING/BUILDING 1:1GARAGE/ACCESSORY STRUCTURE ADDITION 1:1 PRIVY ❑ r <br /> 0 <br /> TYPE OF PERMIT(S): 1 �•' <br /> FILLING/GRADING 11 CAMPING UNIT ❑ SUBDIVISION ❑ / f b-�C.tSrt;j[y <br /> ` T'rn <br /> STRUCTURE/ADDITION USE: U OLk-' )C Se dc4j U-P N 7 VNl <br /> (Home/Cabin; Commercial Business; Bedroom; ) rn <br /> m <br /> BUILDING CONTRACTOR: 6{ <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'h X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> x ie <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> T z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m �? <br /> NORTH(N). y 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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. IN E <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 p0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o t <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN a B <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> CONDITIONS OF PERMIT: <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. OG <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY v <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. 3o. �O `sg = a <br /> O C N y O J �_ <br /> Z 0 COD 2 0 0 <br /> 7. O <br /> cl) : <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ij p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m S <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m O <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 agr ato permit county officials charged with administering county ordinances r other m <br /> authorized person to hq)akaccesg,0fo the above described prpmip asonable time for the purpose of 1 T <br /> O : <br /> O : <br /> SIGN HERE <br /> ( ature ner r b ding co tor) (hate) <br /> ZONING ADMINISTRATOR ✓ ll gnmFn <br /> °' � cNno � .cNi,00 <br /> TOWNSHIP PERMITS <br /> , O 0 0 0 0 0 0 <br /> 7 Y <br /> ZONING I <br />