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Burnett County 7410 Co. Rd. K, No. 102, Siren,W154872 Office of Zoning Administrator v 0Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N » <br /> OWNER TELEPHONE ./ 778-67Zd p <br /> HOME ADDRESS Q�© �.0 EN CiAiRI� �I�� •�/y� L r 9� <br /> EMERGENCY/FIRE NUMBER ROAD NAME C&)4Q sJQ�o .. <br /> LEGAL DESCRIPTION(see tax receipt)6'pWY�7',4e7S l Z'Ru O T OL S8 o� Cir -7– <br /> a <br /> 7– At aZ ` Cn <br /> DWELLING/BUILDING ElGARAGE/ACCESSORY STRUCTURE ADDITION 1:1PRIVY ❑C J 'If Z N0 <br /> TYPE OF PERMIT(S): (p <br /> FILLING/GRADING <br /> El CAMPING UNIT ❑ SUBDIVISION ❑ ^ _ Q q <br /> STRUCTURE/ADDITION USE: V/ IL �T /L Q/ A� 7Y���/L fC/C •7 o r— <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: 2.fir <br /> CD <br /> v � <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 a <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO mI � 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF " I Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. P <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. qj <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 64 <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. ,� o <br /> o 9 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHENq 0 <br /> NEEDED. T 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. N <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <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 /> x = mda 0.0 <br /> 6. 3 c a <br /> 7. <br /> o : <br /> 1N: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofn e <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m . m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- E v <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 d <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 at any reasonable time for the purpose of Inspection. T <br /> : <br /> SIGN HERE <br /> (signal a of o(vner o building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> d"w fn Ex rn w Fn�' <br /> N N Ut N N U1 V7 <br /> U1 V7 O (lV7 O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />