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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r eQ,� � <br /> U) .. 7J <br /> n <br /> /K� '/�'(�_ W <br /> OWNER 1JMI.J I Q,&WT HRt_ 'j MpPJR I Y�I..C` ,(�{N(�(_TELEPHONE fJ. a�Gi _ � v� W <br /> HOME ADDRESS z Q ^I o ;? 0 <br /> �1C1IaSl�AMUJ17QJ ��� �ANgi�tLHr �Y� 5�03� r <br /> 0 <br /> EMERGENCY/FIRE NUMBER 66,/TL4L— ROAD NAME Q <br /> LEGAL DESCRIPTION(see tax receipt) ' m <br /> �y 0 <br /> DWELLING/BUILDING LI GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ rD 0 /* <br /> TYPE OF PERMIT(S): �c <br /> FILLING/GRADING El CAMPING UNIT ❑ SUBDIVISION ❑ `OS <br /> y� N <br /> STRUCTURE/ADDITION USE: ZnfL ANOITIOAI R'�PLAutjf' OLD PoulotJ 1ni)TH M&W 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.)(Dkt, j4,%CTION) 0 <br /> BUILDING CONTRACTOR: Tom4 1RnasCD <br /> E <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> �1 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) <br /> n o. <br /> �+ o z <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 /> c EFo <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m B <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. ' 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. G <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 V <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN CT <br /> NEEDED. 0 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 4-- <br /> ISSUANCE. -ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 1A1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY V" <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> rno <br /> 6' v CDC 00 <br /> CD 0 <br /> : <br /> 7. oM <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of t4a E' <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize QJ. -m m 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 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 to have access to the above described premises at any reasonable time for the purpose of inspection. T <br /> Co <br /> m <br /> SIGN HERE <br /> (s ature o owner or bulloing contractor) (date) <br /> ZONING ADMINISTRATOR <br /> fnwwwwcn� <br /> N N N P 0 <br /> ut u7O � (TO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 000000 <br /> 0000000 <br />