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Burnett Cbunty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -"`0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 � ° <br /> 0 7.J <br /> OWNER U8L =� TELEPHONC)/�/ I�e / c�3 � SolS m <br /> n W <br /> I <br /> HOME ADDRESS � ,� 3 �q GAhrI •Q ISG . �i¢kP �N v O <br /> EMERGENCY/FIRE NUMBER a.3 a 9 <br /> ROAD NAME �� •!t d ry /I` p I <br /> LEGAL DESCRIPTION(see tax receipt) 40 ! Il d <br /> S4/ CD <br /> rn <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ rn o <br /> TYPE OF PERMIT(S): � <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: c <br /> (Home/Cabin, Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: 4 1 I I o tt f/oEr <br /> S <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR `� 1 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. OT a C <br /> DIRECTIONS FOR PLOT PLAN DRAWIN • (AERIAL OR TOP VIEW) M <br /> c <br /> n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. ? <br /> v <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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, f 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 /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 1 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS C O 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 2 o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONEWHEN a v 1 <br /> NEEDED. �C, _ � '. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. )[ C� w� <br /> QONDITIONS OF PERMIT: rr ' o CT <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHI 0 DAY EaI%U&2��yyyy��W <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHOR IUi�"! <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SR�"I M <br /> PERMITTED. �E9NIN <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE IUIRED WATER <br /> SETBACK AREA. e <br /> 5. 5Trre,Cfurt to > L/U1 Tv (✓CE{�t d <br /> 6. S`h-u.c4we, •ftp be- G3' fir.. Le^° erloe o)�=RA ou _U d d o v <br /> M 3 d y 'E X71 <br /> 7.SS fr, d. 4v 6e- l0� i o,•, o f-tc rm c)'P ,ce Z N ° '02 3 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �j m <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 1 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 O <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to h a cess to the above described premises at any reasonable time for the purpose of inspection. ' <br /> T <br /> �--• N <br /> SIGN HERE /J _ (5v Q to E <br /> ( gn ureo owneror ilding ontractor) (date) <br /> ZONING ADMINISTRATOR <br /> 1604'A <br /> N NEn NN 01 (A <br /> Ut NO Nh Cn OO <br /> TOWNSHIP PERMITS MAY BE REQUIRED0 0 0 0 0 0 0 <br />