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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> _ r vt <br /> N a VI <br /> `))2 TELEPHONE (CSl 5 7 g'- 045 b a ' <br /> OWNER � 1. C�I�R� r�LO�'zZ'- o <br /> m <br /> HOME ADDRESS S713 TybMH-08, OOD84RY MQ 5U-'Ir v r <br /> ) 0 <br /> EMERGENCY/FIRE NUMBER �p 4 L4 7 ROAD NAME L r LLQ( L 4 NF= 5. <br /> LEGAL DESCRIPTION(see tax receipt) - ) (� <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION 171PRIW `, <br /> TYPE OF PERMIT(S): I o. <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ �. <br /> STRUCTURE/ADDITION USE: IT ©WLR o <br /> 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) CD <br /> BUILDING CONTRACTOR: JEFF' f-IOWF- J1R�N UJX <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) OT { G <br /> T v Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C <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. 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. <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 Xj 0' C� <br /> MUST BE SIGNED AND DATED BY THE OWNER. Q o 3od <br /> 1n <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN a ° <br /> 0 <br /> NEEDED. 6 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT r I <br /> ISSUANCE. W <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 1 C <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY \ GI <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. v0ryvvv <br /> offmkCJ/ L`-'�'f — [� � 0 m <br /> 11 /� CO. <br /> 7. 1 — 11-6- r Ph(r3�n $tTn�z'kvz ✓ diNeOK— c _� z <br /> Ar, = c' ! ; m <br /> I declare that this application (including any accompanying schedule) has-been examined by me and to the best of my G> c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o. B <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- d G <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 pre ises at any r"�5 ble time for the purpose of inspection. T <br /> J m <br /> CD <br /> Lo - 1:), € <br /> SIGN HERE '� <br /> (signature of own r buildft contr r)/ (date) <br /> ZONING ADMINISTRATOR w fn(n cn <br /> TOWNSHIP PERMITS MAYBE <br />