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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 c� Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> C,,r bi h /7���UW aeSCJQf <br /> m a <br /> m <br /> L ( J <br /> OWNER l r� n�� TELEPHONE //� —��`_ d a CL <br /> oCI- <br /> HOME ADDRESS <br /> 0 m <br /> 0 <br /> EMERGENCY/FIRE NUMBER a S ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) 0 SM S' I! a ► S ) 73- 00 7 <br /> rY S M 7 Y!'/ m <br /> DWELLING/BUILDING 11GARAGE/ACCESSORY STRUCTURE El ADDITION [I PRIVY ❑ o <br /> TYPE OF PERMIT(S): a <br /> Cr <br /> FILLING/GRADyIIN��G ❑ CLAMPING UNIT ❑ SUBDIVISION ❑ / n f� <br /> STRUCTURE/ADDITION USE: Alvi PCE2 ! ���� 0' ` <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) ti <br /> ��/� <br /> BUILDING CONTRACTOR: /T//!'l _SPIrr '� OPS' de <br /> v <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. -n <br /> 0 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p <br /> T n <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m ;b2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). <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 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 k .k <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR ED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONT TC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. to <br /> -I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFIF ION MAY B q g <br /> NEEDED. ✓�� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. e�n O o �n <br /> CONDITIONS OF PERMIT: R/�F <br /> 1 <br /> ISSUANCE.MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMn?NN^p(JN <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. y <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 /> 5. y y <br /> X o0i = 0, m <br /> 6. )p' �3 n `r n � <br /> v m N ¢— <br /> m C m o � 3 <br /> 7. P m m� 1 <br /> o <br /> 1_U) m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my GGi c 10 <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m' _c <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- O <br /> sue a permit. f 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. -n <br /> � <br /> E <br /> SIGN HERE <br /> (signature owner or building c tractor) (date) <br /> r <br /> ZONING ADMINISTTOR / <br /> w 0 CA <br /> UpVVpp <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />