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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -U 0 z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> 5 T <br /> OWNER1) hafe.y- TELEPHONE 763 5/9f/- E/�aU a <br /> v <br /> Asa ► n4ra4oJ"i ecaoc <br /> CD <br /> HOME ADDRESSg 13 RA yt re, -i4rt C /�cyo%! /L'c t' :�✓wJ Ss3 // O <br /> 0 <br /> 0 <br /> EMERGENCY/FIRE NUMBER &SAI /vltat +vW h Rd ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) (g .GtDa� _ G I .�O G ,G o 7 C/itrn 4.4 �rfpJ m <br /> TYPE OF PERMIT(S): <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION'9 PRIVY El <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: cLbr✓t LIJ }; reQ� j <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) 0 <br /> m <br /> BUILDING CONTRACTOR: crv1P Ot.c,i 11pe- <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR CD3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n - <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <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. o <br /> Pill <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND AL TO ` 1 <br /> BUILDINGS, ROADS,LAKE,LOT LINES. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR LLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONT' TOR, �IC., \ 0 DO <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATIO( E DON�)AH NT o <br /> NEEDED. ;�� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. CO <br /> CONDITIONS OF PERMIT: �/'/� <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 /> `lam —TF � '�• ,�1J�� //II^^// <br /> W ✓� 2 3N N O cOD <br /> O f m <br /> Cly->`i ,� IC K, �I a r Z CDCD <br /> y' N <br /> O Tom ' m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my - 2 : : C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o. T A <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognizem CD v m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- � <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 o <br /> authorized person to have access to the above das.Qribed premises at any reasonable time for the purpose of inspection. `D <br /> m <br /> CD <br /> SIGN HERE <br /> (signature of owner or b ilding con acto - (date) <br /> ZONING ADMINISTRATOR \ <br /> l <br /> y� c <br /> TOWNSHIP PERMITS MAY BE REQUIRED UUc)� C� <br />