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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 \n)\ <br /> 0 'V <br /> N O <br /> H <br /> C <br /> n <br /> OWNER D� (�/ Z / a' �/ TELEPHONE ���� 3 � � a ` (1 <br /> HOME ADDRESS 7� _ -Q,.•`& /1v V! <br /> �/ 0/l - o /� <br /> EMERGENCY/FIRE NUMBER ROAD NAMEQEv�Ls l.� <br /> -rF <br /> Z15w9rylSwVleye, C r/O /JC'eo /+#0 <br /> LEGAL DESCRIPTION(see tax receipt)��F 7vZ ` £cG S�cC s m <br /> DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ /I14 C <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ C<5. ^. <br /> STRUCTURE/ADDITION USE:S�uiL�L�/�G' /9+CCG�.S�4/1N S?y�Gtc TK2a' <br /> (Ho /Cabin; Commercial Busi ess; Bedroom; Deck;etc.) y <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8Y:X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 m j� <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. ^' 1` <br /> 0AJS16At-8; ;YO O0 <br /> H y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) iJ T a <br /> In Z <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 ° e> <br /> NORTH(N). \ c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO mS 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. j P <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. I N� <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS �, C�x <br /> MUST BE SIGNED AND DATED BY THE OWNER. o t <br /> I1 v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN Cr <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z U� <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. (n� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Y/ <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER rn O <br /> SETBACK AREA. <br /> 5. <br /> ;a -V 0 r,- vL m <br /> 6. << 3n o. m <br /> `G N C N O <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my \ c p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize A <br /> fD 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 m' <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person jqhave access to the above described premises at any reasonable time for the purpose of inspection. T <br /> SIGN HERE <br /> ( n ure of ow building contractor) (date) <br /> Of <br /> ZONING ADMINISTRATOR <br /> v+wwwv�w <br /> N N N N N <br /> Vt Vt O ut Ot O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 o <br /> 0000000 <br />