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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 /> N O V <br /> N <br /> C <br /> CCL <br /> D <br /> OWNER 1/itr Y Y/�Fl TELEPHONE '7/S-� -336 o <br /> Z� 0 <br /> L '—G Oo <br /> n � n � O� <br /> HOME ADDRESS 313 LLJC� U� ���1 /,�F �� c <br /> r C <br /> o <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> 1/4 <br /> LEGAL DESCRIPTION (see tax receipt) Aj tj n`I, M <br /> � <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION PRIVY ❑ ) (n ° <br /> TYPE OF PERMIT(S): O a <br /> FILLING/GRADINGg CAMPING UNIT ❑ SUBDIVISION ❑ �' <br /> STRUCTURE/ADDITION USE: C!Q P/Yl0 �//GCC�2 ��r� �Sr ° <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) V C <br /> BUILDING CONTRACTOR: <br /> M <br /> M <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> A N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> n <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). fCn 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO mt^ B <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF v} Z <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 <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 o + <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> v <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ` \ <br /> ISSUANCE. OV <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ryry <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY V <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> 5 ja <br /> ACK AREA. I //� ��jjjj � , n ' � / <br /> ,g W/ QtO C - n DODO17 <br /> 17�'l ��// f m <br /> 6. 171�tiz �25Tt luh . g CD a a7. � L� C�t( F11 {� ILX�J/ 71�C1us / � Gx/+Grp// ` �/� o To m <br /> Z N <br /> "< Z1 <br /> o V1 i <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my (� i d - c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of (� o <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize ��\lll <br /> PP ( 9 Y ) 9 iD p <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- �+ C <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 otherYv I <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. -n ° i ' <br /> m <br /> CD : <br /> SIGN HE ) <br /> (signat a owner or (ding contractor) (date) <br /> O <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED C o <br />