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Burnett C".ty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator CD o o <br /> APPLICATION FOR LAND USE PERMITS 3. T <br /> OWNER Al- /5 ' L L TELEPHONE ,7 2 O �p l / / (Y <br /> y� E% OCJ <br /> HOME ADDRESS f p 5�U !ll4YS/bkr Iq /l /Z0- Cr <br /> n ` o <br /> EMERGENCY/FIRE NUMBER �,� e ROAD NAME J Y�L�t9lU 15 1// <br /> pard <br /> (,c)��a - �a 0 <br /> LEGAL DESCRIPTION(see tax receipt) m <br /> c <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY <br /> c o <br /> rr <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING ❑ CA PING UNIT ❑ SUBDIVISION ❑ 5. <br /> LA <br /> STRUCTURE/ADDITION USE: U) V <br /> (Hom Cabi , Commercial Business; Bedroom;Deck;etc.) m <br /> BUILDING CONTRACTOR: �{T�' /- 5 K e � 1 <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR O 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. y O <br /> O m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) nCL Z <br /> nm � <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. mCD <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m \3 <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO p <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF c <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO d � <br /> BUILDINGS,ROADS,LAKE,LOT LINES. O <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADtr T E PLANS "� ? I <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,fwd c <br /> MUST BE SIGNED AND DATED BY THE OWNER. to <br /> � ,,_J <br /> o 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIlI ATIONAIIni BEC <br /> NEEDED. OC <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. BURNEn O <br /> CONDITIONS OF PERMIT: CO <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ZQN�NG COUNTY <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 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA <br /> 5. p� m( 1 3 R OX9.- m <br /> �e 3 vl}`J o am xa m <br /> — <br /> f3 <br /> v � 3- <br /> : m C In w m 0 3 <br /> 6. mI"m o : '`o <br /> 7. =rn: i ; 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 <br /> CL <br /> application(including any accompanym <br /> all information contained in this accompanying schedule)and I further declare that I recognize o <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 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 a ess t the above described premises at any reasonable time for the purpose o inspection. m <br /> 14 ( <br /> SIGN HERE (date) <br /> (signal re ow r or building contractor) ` (z� <br /> ZONING ADMINISTRATOR <br /> N N N N I T N <br /> (T (T O f)1 Ut 0 0 <br /> 0000000 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />