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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> r APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N 0 <br /> C <br /> OWNER J M p�� <br /> TELEPHONE f, v <br /> d <br /> HOME ADDRESS 6 l U� hn r -� A u lit <br /> �r f At✓t 0k1 \o� <br /> EMERGENCY/FIRE NUMBER <br /> A P��( F-Q� RO NAME <br /> 7-W 0(t, eta <br /> LEGAL DESCRIPTION (see tax receipt)Ccrtvu d'tl� ���� 0 <br /> ///��� <br /> DWELLING/BUILDING J4 GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY y 0 <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ c <br /> STRUCTURE/ADDITION USE: (�(O ✓� ( _N� l /�C� I �� C��Ci I 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: � g <br /> .� <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. <br /> 0 <br /> � N � o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T o. <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y 0- <br /> 3. SHOW SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m r \ <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. c <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO c' <br /> BUILDINGS, ROADS,LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <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. ��! 0 Q <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN qS <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z �p <br /> CONDITIONS OF PERMIT: 0 ` ( n, <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. O <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 /> AID m cOn L <br /> 3 nm %Q <br /> 6. v g; CZ : 0vNmo � 3 <br /> 0 <br /> 7. 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 ofo C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognizem ;a <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- i p <br /> sue a permit I further accept all liability which maybe a result of the County of Burnett relying on this information 1 am <br /> providing in his application. I agree to permit county officials charged with administering county ordinances or other \ . <br /> authorized p on to have access to the above described premises at any reasonable time for the purpose of inspection. : <br /> SIGN HERE �I <br /> (s <br /> i <br /> g <br /> netur of owner or building c tr ct r (date) v <br /> ZONING ADMI ISTRATOR _ <br /> � CANW <br /> N N U1 N N N <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 <br /> 00000 0 <br />