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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 548726 Office of Zoning Administrator �V' <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> 0 <br /> N <br /> OWNER 80L,,,.j i- CC <br /> r✓D TELEPHONE I _ d <br /> / / L--d, <br /> i <br /> HOME ADDRESS /7 Op) 3 .J c U O G / IQ [_dI'n <br /> `` q ✓ o � <br /> EMERGENCY/FIRE NUMBER J / Nafll � �r ROAD NAME <br /> 1 <br /> 11 1 <br /> LEGAL DESCRIPTION(see tax receipt) L p/ Z / �6 w 1G� 7 Tc1r1 N IJ y <br /> ° <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION-X PRIW ❑ 0 <br /> TYPE OF PERMIT(S): j c <br /> or <br /> FILLING/GRADING ❑ CAMPING UNIT [ISUBDIVISION ❑ -KT 5 r <br /> STRUCTURE/ADDITION USE: Dorm e-(- o <br /> i (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) � <br /> BUILDING CONTRACTOR: C�- 11 n L aon Lo � ��oYn-0 <br /> �� 5 -o2�y-3s3s p o F.3 Ux �, 75- DSCGc> CJ,' s oZ <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> I;V N <br /> DIRECTIONS FOR PLOT PLAN DRAWING- (AERIAL OR TOP VIEW) p m <br /> n m <br /> TZ <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 !D <br /> NORTH(N). <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 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. xJ <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 8 <br /> MUST BE SIGNED AND DATED BY THE OWNER. �� o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN 1 o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <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. \ <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 /> s. <br /> CDa M <br /> � ' o' <br /> 7. <br /> o A <br /> S2 m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 1J <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <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- p <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 personlo have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> m : <br /> e, <br /> SIGN HERE e17 640 <br /> (signal re f oK+ner or buildin co tractor) (date) <br /> ZONING ADMINISTRATOR GL, <br /> N <br /> °t O P P N [T O NU1 <br /> °t O <br /> WNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />