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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 G) Z <br /> APPLICATION FOR LAND USE PERMITS 3� - <br /> r <br /> tt N <br /> OWNER �.� �`1P�1'2� M <br /> TELEPHONE 6S�-y 3 S6 a <br /> I o <br /> HOME ADDRESS O <br /> EMERGENCY/FIRE NUMBER -2129(02 ROAD NAME s W�q Q.C- �� l <br /> V <br /> LEGAL DESCRIPTION(see tax receipt) LAti+2 ` - �[ / /� / <br /> r�MIr k4 Lar. o toCLLR/X in r/1V t 'O11 7d <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION PRIVY ❑ ' 1 o <br /> TYPE OF PERMIT(S): c 0 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑V SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: n r_K �� /� l ( L o —� <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) co <br /> m <br /> BUILDING CONTRACTOR: <br /> w <br /> CD <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n - <br /> O <br /> �I N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n o Z. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m C� 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 'D <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO O <br /> BUILDINGS, ROADS, LAKE, LOT LINES. G <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 ° <br /> MUST BE SIGNED AND DATED BY THE OWNER. 2 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFIC I E DONE WHEN o <br /> NEEDED. (q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. r r ` : z G <br /> CONDITIONS OF PERMIT: J_ ��� j„',i ��,� P <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OFAStW T <br /> ISSUANCE. //�I// <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORE RELI <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY /V� COQ <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHINTHEREQUIRED W/AR• R <br /> SETBACK A.��VQ �P 4✓�/I t P.!/( I I <br /> 5. <br /> ! m e � a * M <br /> 7. <br /> /LSI✓ l/l t o 4L Wim{ / O O /ley// w //c V n y N O _ <br /> I declare that 1his application (Including any accompanying schedule) has be6h eidamined by me and to the best of my <br /> A <br /> C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ` m <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <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 other o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. `D <br /> m <br /> m : <br /> SIGN HERE v> <br /> gnatur caner or build' g 'ntra r) (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP P RMITS MAY BE REQUIRED <br /> �� <br /> tiv33� <br />