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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v ci Z <br /> APPLICATION FOR LAND USE PERMITS 3 ° <br /> r <br /> C <br /> OWNER �l N TELEPHONE r jd,-g$Q <br /> HOME ADDRESS l 1 /�lt D(�I VC 111 <br /> EMERGENCY/FIRE NUMBER Z31 4q b DuYl"h, LA k-& OAD NAME <br /> - <br /> LEGAL DESCRIPTION(see tax receipt) /'lJtn -7 ulc3b� <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ V1 ?• <br /> TYPE OF PERMIT(S): c� <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: e�filh ��� t2_ 0' $ <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) y <br /> BUILDING CONTRACTOR: rL lnfwt rJl/ Oa " <br /> v <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 /> �I N rrte�,, <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 c W <br /> TZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m �? <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO lm —v �, <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <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 s <br /> BUILDINGS, ROADS,LAKE, LOT LINES. <br /> S. 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. c <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q 0 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT C> <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 I <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> �QSETBACK AREA. <br /> 5. t/lv ;a-0 co DaO -0 <br /> m <br /> 6. M c m wog 3 <br /> _ m C w _ <br /> Z : �, 0o Ifo <br /> 7. o . <br /> fur. im <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c 1.3, p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of 11 ��,, m c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize Vv 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 O <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 e� <br /> authorized person to have access to the abovpwcribed premises at any reasonable time for the purpose of inspection. (,moi, <br /> m <br /> SIGN HERE ` S��I (�) i S <br /> (signature er or building contrac r) (date) : i <br /> ZONING ADMINISTRATOR <br /> cn v+w Fn <br /> N V 1 N <br /> Vt O Vt N <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 oil dp <br />