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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator-0 0 o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> �* r <br /> 1Jff4*erro <br /> 430) �'� tilo i o <br /> F�SJ - 437- 3/ !� <br /> OWNER TELEPHONE t o#L �sien l� 7/5- 3`�- //� a <br /> HOME ADDRESS <br /> l ;z -3 / /1(_iDLAr,TV Pd jE S�ixoh&r 1'('`L' S1-$ QS) <br /> � r � <br /> EMERGENCY/FIRE NUMBER J ! ROAD NAME ea yam„T 'ed F ° <br /> / O <br /> LEGAL DESCRIPTION(see tax receipt) r /Pte. 14 W ` m <br /> a <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ PRIVY ❑ rn ° <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> ' N <br /> STRUCTURE/ADDITION USE: hLtA P -100>^ C/ b, n 0 <br /> (H me/Cabin; Commercial Business; Bedroom; Deck;etc.) Cn <br /> BUILDING CONTRACTOR: 1 V, <br /> A PLOT PLAN MUST BE PROVIDED PIN AT LEAST AN 8%X 11 SHEET OF 9SAJER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> A H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O (D O <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m :° �'( <br /> NORTH(N). nl/1" <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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. o <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. to c <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a ,� <br /> NEEDED. 0 _ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z �. <br /> CONDITIONS OF PERMIT: c <br /> Q <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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 X� <br /> PERMITTED. O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER v <br /> SETBACK AREA. <br /> 5. <br /> W -0 Oro <br /> (D '. m (D <br /> 6. i; � 3n� *.am9zm <br /> (D C <br /> 7. Z N (D <br /> O <br /> =y: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m i? C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize (D m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- p <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 premises at any reasonable time for the purpose of inspection. m <br /> : <br /> m : <br /> SIGN HERE <br /> 4A,3'/0 <br /> (sign atutureeoof owner <br /> or building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 0 0 0 0 0 0 0 <br />