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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator0 o o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> y, O <br /> N <br /> d <br /> OWNER ✓ � TELEPHONE) <br /> CD 0 <br /> HOME ADDRESS r y-�,o yea? <br /> EMERGENCY/FIRE NUMBER ROAD NAME A <br /> a� �Sn1 �� 4Va(S $c�c Loi � <br /> LEGAL DESCRIPTION(see tax receipt) L o} G, ' � a m <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ 1 rn 0 <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADIN��G��❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: `DI/-'7" W)h �y�,_+�`\��� 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) C <br /> BUILDING CONTRACTOR: ]�LXI"Z A 0ms-&ra xtdd-r- it <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8Y:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3. <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T - <br /> x <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> In Z <br /> XJ/ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m " I Z <br /> SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS WS)4ND7IL1- IEW BUILDING NB AND INDICATE m :° <br /> /NORTH(N). y c <br /> ?' 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. ti . P <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO Q p <br /> BUILDINGS, ROADS,LAKE, LOT LINES. 1 K <br /> 6. 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. o <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN �. <br /> NEEDED. � cq� n 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: 7 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. t <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 1 ©° <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. /v/C rte/ <br /> o-a3-oma Ke� tea, � � 0 � oo <br /> 6. (D �� ay M <br /> m c w > > r. <br /> 7. D' '�g Z : mm °�� `° i <br /> I declare that this application includin n accompanyingschedule has been examined b me and to the best of m a : p <br /> PP (� Y ) Y Y � �� <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of C d C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize o.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 /> CD : <br /> M : <br /> SIGN HERE <br /> (signature of owner or bullding contractor) (d te) <br /> ZONING ADMINISTRATOR 1 i 40 <br /> 44 <br /> 40 <br /> i 4 cs <br /> N NfTNNtn(n <br /> (JtT O fl1 fl1 O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />