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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o° o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> n <br /> OWNER <br /> -7,5 TELEPHONE <br /> HOME ADDRESS NO/ <br /> EMERGENCY/FIRE NUMBER ROAD NAME�6&-14&e Abwz <br /> Lata vol ��e g, �3 w aiy 'ply '� <br /> LEGAL DESCRIPTION(see tax receipt) �� /� Sf✓ I��S.19 rsllN RISW � �GU��. U v, <br /> ��Qp(( <br /> 0 ' <br /> DWELLING/BUILDING E9 GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ o) 0 <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ /CAMPING UNITE] SUBDIVISION;-�❑ /� 5 <br /> STRUCTURE/ADDITION USE: 6t9hdA/ r X I I��l Q-ei l - ° <br /> (Home//Cabin; Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: lir <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81Fi X 11 SHEET OF PAPER. ANY INCOMPLETE OR n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> M c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T o e <br /> T 0 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE rn n <br /> NORTH(N). y O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m ^ 3 <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 p <br /> W (^� <br /> BUILDINGS,ROADS,LAKE, LOT LINES. �J <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS cYw" <br /> MUST BE SIGNED AND DATED BY THE OWNER. ^o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHENV� q ° ` <br /> NEEDED. (/q <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. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 1 <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. (��� �7 [, 7��� <br /> 5. �-'I U► '' / n �l IL LS!. b-- r/Q-/'Y1 d'2,re <br /> 0 50 m <br /> 6, l 00 r' t(J i fv) &YrI p S� CK M m c td_ .'0 <br /> a CDCm . os3 <br /> Z N (we <br /> 7. <br /> 1 , 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 ofn E! <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> C m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- O <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am a <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_tlke abo described premises at any reasonable time for the purpose of inspection. m <br /> CD <br /> 4e/!y199 <br /> m : <br /> 49 <br /> SIGN HECE <br /> ( q of o neMorbng contractor) (date) <br /> ZONING ADMINISTRATOR 0 <br /> wwfnww <br /> N ppop 0 <br /> 01 <br /> V1 V1 O U� I71 O <br /> O 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 <br />