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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v G) Z <br /> APPLICATION FOR LAND USE PERMITS 3 ° <br /> r Q � <br /> m o <br /> OWNERTELEPHONE n <br /> 7harK + TELEPHONE X51-30(�- ► 5�5 a <br /> CD <br /> HOME ADDRESS ,�'zo� ��a me t)-R K y <br /> ��� � lroJe � wFtts t71� S5 e7� <br /> r m <br /> 0 <br /> EMERGENCY/FIRE NUMBER f�O �Q 9 49 ROAD NAME <br /> CatfiP'If 0t2- 45.01 -t0-1 by— <br /> LEGAL <br /> y_LEGAL DESCRIPTION(see tax receipt) o t 5 - rt ^'�O '1 s S rn Jt4 Q t r rp , c of Lt �� �p t b y <br /> m <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ y o <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNIT <br /> ❑ SUBDIVISION ❑ a <br /> \\ .T. T) <br /> J <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom;Deck; etc.) Cl) <br /> BUILDING CONTRACTOR: �� G C S"J G a -T d E <br /> v (n _ <br /> Q <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR .n3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> O <br /> M N (\ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m J a( <br /> a (� <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <7 m 4--_�o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m :° <br /> NORTH(N). c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m s <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF p <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ' 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 PLANS (� <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 1 <br /> _v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN " S <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT l j w <br /> ISSUANCE. (^ C5 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY -Ij <br /> PERMITTED. G <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> M v 0 lr,- <br /> m _. mom m m <br /> 6. �' OM <br /> 3o.NN M <br /> D c N o S 3 <br /> 7. Z : `" m <br /> P : <br /> y: <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �j p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m e <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m . <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- Q 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 m <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have accei@ to the above described premises at any reasonable time for the purpose of inspection. <br /> Q : <br /> (D : <br /> SIGN HERE <br /> (signature f ow)Ir or building contractor) (date) <br /> ZONING ADMINISTRATOR I'M 0111 G �: <br /> N N (71 N N fll N <br /> V1 V1 O (n N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED �0 0 0 0 0 0 6 <br />