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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 /> Lk L <br /> ' <br /> OWNER <br /> CL <br /> s�e�ea �C C�k. a'TELEPHONE ��j` � f/p // <br /> HOME ADDRESS J/CK �OGL [.[tKG r <br /> cStcc C�fs ih ry 9 <br /> m <br /> EMERGENCY/FIRE NUMBER 60167 ROAD NAME S�1LoK60Qtr 2d G <br /> TZ) A OaCi 4-3,23 o Soo ! 'cit 7 i <br /> LEGAL DESCRIPTION (see tax receipt) $•e�o fh 23-40.—/(o ak5l_ 0) <br /> 0 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION 5�r PRIVY ❑ e <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ ? , <br /> STRUCTURE/ADDITION USE: dd&' <br /> /� (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) y 7�/ <br /> BUILDING CONTRACTOR: grW'S 6'Ac, fd6Le --P ' 7 �i(h/— �e` ,n. <br /> v Q1,^� <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/s X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 \S�!' <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 I r <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 ; D lJ <br /> 0 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> o Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C O� <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO cc m C 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OFQj \p <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. N 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 PLANSo <br /> MUST BE SIGNED AND DATED BY THE OWNER. ( 5 o <br /> o � <br /> too <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. Cr I r <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z O <br /> CONDITIONS OF PERMIT: <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. LU 1 , <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 /> A v 0r- 0�0 .0 <br /> 6. �o � a nN <br /> (D C m <br /> =V) <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 ofCL <br /> m C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 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 aqefiss to the abov desc 'bed premises at any reasonable time for the purpose of inspection. -n <br /> m : <br /> SIGN HERE <br /> (signatur a building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> � <br /> N CA Cn 0 <br /> N 0 N N P P <br /> V1 O� O [T U1 O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />