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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 4, <br /> N J— <br /> Pr✓ 3CI17— 7473(1n o <br /> OWNER TELEPHONE <br /> HOME ADDRESS W' e-L W t S' ! g?JC� v N <br /> 1 r <br /> D(� C <br /> EMERGENCY/FIRE NUMBER �u ROAD NAME <br /> �y-� wry r w <br /> LEGAL DESCRIPTION(see tax receipt) �L / L �/' 1 I fS 3 - 1(� 1 or <br /> 3 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ c <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ o; <br /> STRUCTURE/ADDITION USE: > <br /> ome/Ca ' ; Commercial Bu loess Bedroom; Deck;etc.) m <br /> Q / �(/ �p m <br /> BUILDING CONTRACTOR: �DS ECUCS t0 1100 LdC-ti1 4 Ildl ` � 1 0l <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> �1 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> ?� O Z <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). C c <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 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 I <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 PLANS 0 i <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN cr <br /> NEEDED. 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: <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. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 1 ,1 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> m =. md <br /> 6. iPe,� � a &LI; <br /> > � Cyy .� 093 <br /> 7. 0 N Zh'< � 'P -f <br /> o . <br /> s (a: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of E <br /> all information contained in this application(including an accompanyingschedule and 1 further declare that I recognize m m m <br /> PP (� 9 Y ) 9 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is <br /> 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 ; w <br /> providing in this apihication. I agree to permit county officials charged with administering county ordinances or other E o <br /> authorized person tfinave access tjf top above described premises at any reasonable time for the purpose of inspection. T <br /> CD <br /> SIGN HERE <br /> (s g ure of owner or bui /nog�contractor) (date) j <br /> ZONING ADMINISTRATOR /XL_ <br /> w v+ to to cn 01 <br /> N N NNutN <br /> N N O NU100 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />