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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N O^ <br /> TELEPHONE <br /> OWNER 4f C'/y 'L--j C� y9 co <br /> HOME ADDRESS 51/4jd 5 / 0 41 4- /h /v Z v o <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME M I N fX u A L^/DiaC W <br /> LEGAL DESCRIPTION(see tax receipt) '7 l S h--1 v b p G 9/l g o 3S- � � l�s ) CD <br /> DWELLING/BUILDING FLI GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ 0 <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ y <br /> STRUCTURE/ADDITION USE: 02 x 3,3, O <br /> c r (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) C <br /> BUILDING CONTRACTOR: > C L f <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 G <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n ii S <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE rn ° v n <br /> NORTH(N). N ° <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 13 <br /> 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF o <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. I \ <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. rGil w <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS �. <br /> MUST BE SIGNED AND DATED BY THE OWNER. ° <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN i S <br /> NEEDED. 2 T <br /> Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. P UJ <br /> CONDITIONS OF PERMIT: \/j <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 O <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SE BA�AREA. 1 / /' <br /> 5. CG I'2� ry�lC I '(fit ��F�Ck3 (�/�/ /"l��C K.f"EQ.f= ; m d + ° m <br /> Lk <br /> N `G N 7C <br /> 6. N Q C N O 3 <br /> tl O O <br /> T <br /> P : Cn [ i 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 accurv#y of o <br /> all information contained in this application(including any accompanying schedule)and I further declare that IM 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 <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 <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. m <br /> m : <br /> nr <br /> SIGN HERE v <br /> (date)) <br /> (signature o Woer �ugijjgfdgWactor) <br /> ZONING ADMINISTRATOR /6 'v v <br /> cn wcn to to tn� <br /> N h)OI N N °1 <br /> N V 0 <br /> 101 010 0 0 <br /> O 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED O o 0 0 0 ° <br />