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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -U o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> - r <br /> N <br /> OWNER ^Tom m`I m ot' e TELEPHONE 7 a <br /> v <br /> HOME ADDRESS 1 <br /> �4 f� � ^ �1 <br /> C��IfC� DSS I2c� Slj v <br /> 11 o r' f <br /> EMERGENCY/FIRE NUMBER Z`l��(P 1 ROAD NAME 20Lid 111 <br /> LEGAL DESCRIPTION (see tax receipt) }W— FA_ ' U <br /> U I� <br /> DWELLING/BUILDING 1,61 GARAGE/ACCESSORY STRUCTURE Efl ADDITION ❑ PRIVY ❑ (n c <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5 <br /> STRUCTURE/ADDITION USE: 2-00\ Z9 K COO/ 1� 7Lkhl f 6A31 de- <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) W <br /> m <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. In _ <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O In n Q�Q <br /> In z }y <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m fD, <br /> NORTH(N). C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDINGS)TO m I a <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. ( 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 X <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR,ETC.,THE PLANS l?_ <br /> MUST BE SIGNED AND DATED BY THE OWNER. c _� <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHENa B <br /> NEEDED. 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. f <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY -i <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> XT0rr- 0 v <br /> 6. 8 3 CD S <br /> n.m <br /> : fe O N b <br /> 7 Z N , <br /> O <br /> E:* m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c Q <br /> knowledge and belief it is true, correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of m 0 C <br /> CL . . . <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m .� <br /> m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- y t7 <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 m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. -, <br /> CD <br /> m : <br /> SIGN HERE <br /> ignature�of owneror <br /> building contractor) (date) <br /> ZONING ADMINISTRATOR V I(}1 r 1011 ) . . . : : . <br /> N N Ln N N N <br /> VI Vt O N 07 O <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 8000 <br /> 0 0 <br />