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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 <br /> y O <br /> N <br /> OWNER (��„ TELEPHONE c <br /> ,4. R 7[5— 3 �_ 769 <br /> HOME ADDRESS 33 T9 5� rr41l �z all 5 93 <br /> r m <br /> Nun ° <br /> EMERGENCY/FIRE NUMBER2-3 ROAD NAME <br /> ;L8-;�3 V aoglo 337 5-414111/t/, <br /> LEGAL DESCRIPTION(see tax receipt) 24 PCL Goy Ld k4 / <br /> 1 <br /> �yo <br /> DWELLING/BUILDING ❑ ^ R&GrE/ACCESSORY STRUCTURE © ADDITION El PRIVY 1:1 —V N <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNITE] SUBDIVISIONE] <br /> n <br /> S. <br /> _/ -G <br /> T. <br /> STRUCTURE/ADDITION USE: �TOr4* — / AG/JI o <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) y <br /> BUILDING CONTRACTOR: / G LE N. <br /> v <br /> CD <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 /> x y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <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 C n <br /> NORTH(N). N O <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. 9 <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. `L <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. IV <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. m so ) <br /> O 9 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN m o <br /> Ct <br /> NEEDED. 0 (� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z �G <br /> CONDITIONS OF PERMIT: (c <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I <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 ( � W <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER C7 <br /> SETBACK AREA. <br /> 5. <br /> CD <br /> o. m <br /> 6. (DCN '" o_ S3_ <br /> 7. Z O . N j� <br /> =y : m <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my Zj c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ; n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize �i m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- v <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 <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. m <br /> m : <br /> SIGN HERE <br /> (signatur f owner or building n actor) (date) <br /> ZONING ADMINISTRATOR . . . . . fA <br /> fn v+v+v+v+ <br /> N N VINNU N <br /> N [T O (]19100 <br /> VC RMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br /> 0000000 <br />