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Burnett Oounty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -U ci Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> A /,z 0 'Re We, � v� <br /> V <br /> / �7I� Q C <br /> OWNER ZR/a1 P-e YLG� �ag na t1. TELEPHONE �j^! - �l! '�rJ�' ' o e <br /> HOME ADDRESSr * CD O� <br /> r <br /> r � <br /> EMERGENCY/FIRE NUMBER ROAD NAMEtaie d. <br /> O <br /> LEGAL DESCRIPTION (see tax receipt) t.C� CSS-, V y r� /17 _-/ Cn <br /> e <br /> CD <br /> DWELLING/BUILDING 19? GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ U) o <br /> TYPE OF PERMIT(S): ' a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ or <br /> < (� <br /> STRUCTURE/ADDITION USE: �r91y1 <br /> R./G &b ,`� IJo <br /> (H e/C bin; Commercial Business; Bedroom; Deck; etc.) y <br /> �1 d <br /> /Y12. <br /> BUILDING CONTRACTOR: ' / Q r�� ^�Ile. t ' r>? Q ���}L r TN St <br /> o <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. AN INCOMPLETE OR 3 �. <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m = W rn <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <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)OF Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 1 0 <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. 0' <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 PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. QIP o i <br /> I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 <br /> NEEDED. <br /> a <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 0 1 <br /> CONDITIONS OF PERMIT: O <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. W <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. <br /> 6. ��a / m dofM. , It) <br /> "O N C N N <br /> U, N O7. <br /> o m <br /> = o ' A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G m <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of a <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize E t7 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> ID <br /> CD <br /> SIGN HERE�i/✓L4 , r�'7 G►t Qillt.i �^ ,� <br /> (signature 6f or or building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />