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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administratoor -00 o <br /> APPLI TION FOR LAND US PERMIT 3 <br /> �- "� dad 2�`d �cu.� <br /> OWN .N/' /v1�/' , _' TELEPHONE � <br /> HOME ADDRESSm O <br /> EMERGENCY/FIRE NUMBER �r � P ROAD NAME <br /> cL <br /> L <br /> 6z- <br /> LEGAL c— <br /> LEGAL DESCRIPTION(see tax receipt) 3 17b \do m <br /> m <br /> DWELLING/BUILDING 1:1GARAGE/ACCESSORY STRUCTURE M ADDITION Z PRIVY ❑ y <br /> 0 <br /> TYPE OF PERMIT(S): or ' <br /> FILLING/GRADING ❑ PING UNIT ❑ SUBDIVISION <br /> I/_ N <br /> STRUCTURE/ADDITION USE: 7Z Y/to �?— U ( IJU <br /> (Ham / abiComme ial Business; Bedroom; Deck;etc.) rn <br /> BUILDING CONTRACTOR: 'L ►T ��, <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR ,n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n 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 C n <br /> NORTH(N). co 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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 <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. r <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN Ct <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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 <br /> PERMITTED. J� <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER l� <br /> SETBACK AREA. <br /> 5. <br /> 3 ' m <br /> 6. V f' C to y O <br /> 7. O N �`� i <br /> in <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of myZi i C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofo IF <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <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 : m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other E m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> m : <br /> m <br /> SIGN HERE ���^ Qu Lif i <br /> sign ture of owner or bum in contractor (date) <br /> ku C O�° Y <br /> ZONING ADMINISTRATOC 4be in�w 40 N 40 <br /> N K) M Up Cn <br /> Oi Out UtOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 000 c <br /> --I--- <br />