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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N 0 <br /> N <br /> C <br /> u q W _ 1 <br /> OWNER mtLAI,�Qe,� � Cs"Slie� M(, !2l TELEPHONE <br /> _ �1 ` {�� �S '� pv`NtJ <br /> HOME ADDRESS J���pS �Pca�et' �1tL� L Jt II NJ 1 11 l� �^ "' r <br /> ' r <br /> EMERGENCY/FIRE NUMBER Sw s o �; ROAD NAME LIN LQ„ e- <br /> ^ <br /> �►f �3lr- a•tow^Sk es 2 yl -llr'II- I oo rnefC wKl4n owO .POa�UD <br /> �( <br /> le-'J" CvKn 1� -40-Ib- <br /> LEGAL DESCRIPTION(see tax receipt) II La l <br /> 6+ I j ^�tn y L; CJa[I 14Kc l4�^I ^J q c I 0 <br /> DWELLING/141-111 GARAGE/ACCESSORY STRUCTURE ADDITION PRIVY ❑ 1y'n5 / V) 0 <br /> TYPE OF PERMIT(S): bin `h � aor <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5 <br /> STRUCTURE/ADDITION USE: 1 A C, <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) U <br /> BUILDING CONTRACTOR: I G <br /> v <br /> M <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. p <br /> A <br /> (AERIAL OR TOP VIEW) O cL <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. mA 1 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C EF <br /> NORTH(N). y 3 <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 e <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 2 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o i <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q Q <br /> NEEDED. T <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 O <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. , d d , COD ?X>� m <br /> 6. N aN y <br /> L • m c w , o 5 3 <br /> Z : COD <br /> _ <br /> Cn <br /> R , m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ff c C <br /> �.1J <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of ,� o E' <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize I rt fD (^ m <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have acce s to the above described premises at any reasonable time for the purpose of inspection. m <br /> CD <br /> m : <br /> SIGN HERE <br /> a3-9 <br /> (signs roof ownero building tr ctor�)j� (date) ? i <br /> ZONING ADMINISTRATOR �� 69 <br /> 4A <br /> N N N N N - <br /> (TI (T OVI O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 00 000 <br /> � o0 000 <br />