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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 � <br /> 41 <br /> C � <br /> N <br /> OWNER OE' CL <br /> Qnd TELEPHONE qSa- 9yj-s7o:7 <br /> HOME ADDRESS 27529 Cfd4p Doan T(Ad, fAed Pfa1le , MN S.s3V9 v � <br /> 4J n r � <br /> EMERGENCY/FIRE NUMBER a 1 A2 ROAD NAME C 1 eHT V r eV PC/. I o <br /> LEGAL DESCRIPTION(see tax receipt) L D4- 7 Sn-- T. :? p N- e ) 9V f C (' <br /> DWELLING/BUILDINGe <br /> GARAGE/ACCESSORY STRUCTURE ADDITION 54 PRIVY ll (n o �y <br /> TYPE OF PERMIT(S): C ' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: 0A Q)c/5l r/q Deck <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) w (� <br /> � m <br /> BUILDING CONTRACTOR: Tf Ge 60A54fVC1 r o^ CID <br /> iu <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 9 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> ?� O kZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE rn <br /> NORTH(N). CO) <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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. <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 /> 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. <br /> o I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFI¢ Y BE DONE WHEN <br /> NEEDED. ������ Nv <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: \ <br /> c.!i I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS��ERMIT- �/ <br /> ISSUANCE. ��jj <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHOR ���? <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPEC[FICALLI�Q•^'/�/�cou, ' ; <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRE)WA ERN r <br /> SETBACK AREA. <br /> 5. <br /> ;o _ 0 r. M grn <br /> 6. v NCuNimo=' rom _ <br /> - : .'O <br /> fn <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �j c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o –Pr -C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize rn <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 I am <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 aany reasonable time for the purpose of inspection. m <br /> CD <br /> m : <br /> SIGN HERE � <br /> ure of o n o i on r) (date) <br /> ZONING ADMINISTRATOR w <br /> N NCnNNU1N <br /> V7 NOut VtOO <br /> TO NSHIP PERMITS MAY BE REQUIRED 14N1'' 0 0 0 00 <br /> 0 0 <br />