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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 /> r el <br /> OWNER e1 O Li / -e ��tom? // TELEPHONE <br /> 1 1 r--� `� � OJ <br /> HOME ADDRESS C2ka10 tj, lnNr �/ou v.a i �Tf(l� �y <br /> EMERGENCY/FIRE NUMBER ;t8g,10 ROAD NAME �woo ja 12 <br /> J �1 <br /> LEGAL DESCRIPTION(see tax receipt) L G t W(`IT) V �� P40 7— (10—AL <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE X ADDITION ❑ PRIVY ❑ ) m ° O <br /> TYPE OF PERMIT(S): <br /> Cr <br /> FILLING/GRADING ❑ CAMPING UNIT 1:1SUBDIVISION ❑ 5 <br /> N <br /> STRUCTURE/ADDITION USE: q r4 ct1I a Y lCay <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) rn <br /> m <br /> BUILDING CONTRACTOR: e'rS <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/]X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. .S1 O <br /> y 1 0 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) //��yj/^ 3 O cL <br /> TZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. A � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C ? Q 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 NJ <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF eI <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. c <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO r� <br /> BUILDINGS,ROADS,LAKE, LOT LINES. v C <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. ro 0 I <br /> O 9 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q S <br /> NEEDED. J <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> CONDITIONS OF PERMIT: o Q <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. I <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. <br /> 6. � � 9 CL CD –ac t <br /> ED C10 0 o 0 3 <br /> z '^ m <br /> 7. o <br /> lo, : m <br /> PP (including Yaccompanying ) Y y : meq ; <br /> I declare that this application mcludin an schedule has been examined b me and to the best of m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o. C <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize m <br /> M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- O <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am m <br /> providing m this application. I agree to permit county officials charged with administering county ordinances or other m <br /> P g pP 9 P tY 9 9 tY <br /> authorized person to h ccess to the above described premises at any reasonable time for the purpose of inspection. T <br /> m : <br /> p m : <br /> SIGN HERE <br /> (signArli of owner or bu i g contractor) (date) / <br /> ZONING ADMINISTRATOR fn <br /> N N01NN 01 En <br /> Ut U1 O (!1 U1 O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />