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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator o <br /> APPLICATION FOR LAND USE PERMITS 3el <br /> r- <br /> 0 <br /> a , <br /> OWNER 56�) TELEPHONE (GS ^2 c <br /> A m <br /> !Y' <br /> O <br /> 13982 3/� �' C'E�2 C'�7v 0-1-jSSGI 2 v <br /> HOME ADDRESS � I <br /> � r c" <br /> ' <br /> EMERGENCY/FIRE NUMBER (�Y ROAD NAME <br /> LEGAL DESCRIPTIONt see tax receipt) <br /> c p) �i 5 C�srn V /3 �. �l0 o <br /> �-y <br /> DWELLING/BUILDING LI GARAGE/ACCESSORY STRUCTURE 1:1 ADDITION ❑ PRIVY El1 fn o <br /> c <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADINWOA� <br /> CAMPI UNIT El SUBDIVISION ❑ °' <br /> S. <br /> La <br /> STRUCTURE/ADDITION USE: A 0 <br /> (Home/Cabin; Commercial Business, Bedroom; Deck;etc.) Cn �J <br /> m <br /> BUILDING CONTRACTOR: lir <br /> v < <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/z X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> �l N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T ii <br /> z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. t7 m w A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C :° q-) n <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OFZ <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. `L <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANSf <br /> MUST BE SIGNED AND DATED BY THE OWNER. 6o I <br /> 0V o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN W LQ <br /> O <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z ll� <br /> 0 <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. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY rr <br /> PERMITTED. w <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> L m <br /> 6. �' � 3 L0 Xa. <br /> mCy " o s3 <br /> MWo <br /> _v,: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of d <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize � D 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. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am m <br /> providing in this aMacation. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized pe n to ave ac ss to bove described premises at any reasonable time for the purpose of inspection. -n <br /> CD <br /> SIGN HERE <br /> (signatures wrier or ildiing,ccntractor) (date) <br /> ZONING ADMINISTRATOR <br /> N N V I N N U <br /> (11 Ui O M fT O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 00000018 <br />