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Burnett County 7410 Cn. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ' o 0 <br /> AOPLICATION FOR LAND USE PERMITS .��$ c y. s <br /> ,,d 8$R '7 y <br /> OWNER �� y ��� TELEPHONE <br /> HOMEADDRESS "?7Y 14 1j, ��RM 2p He bso&i 6dl SYoi6 O <br /> r � <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME 4f,444? �� \ <br /> LEGAL DESCRIPTION (see tax receipt) L b \ CD <br /> �i <br /> 2p � <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION A PRIVY ❑ J��JO -- �7 _stn 0= <br /> TYPE OF PERMIT(S): �z / / Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ ��J��{�{rj,Cn.(�Jj n- <: <br /> STRUCTURE/ADDITION USE: Po.��N l oX I�' � )C S 1 3 `%/(LCL o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;a c.) m <br /> BUILDING CONTRACTOR: R u S S util�yE/� <br /> T <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p " U) <br /> �I N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> -n <br /> T ` Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> C \ o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO ED <br /> m 3 <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. ° <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 Q <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> f p � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN �o ° Jj <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. .0 1 <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. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> M M. n r O D 0 -0m �1no o m n IT <br /> 0 < 3 m � �" f <br /> 6. <br /> Z : m m O <br /> 7 O 21 ,ZI <br /> - �: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 0 - O <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o g <br /> all information contained in this application(including an accompanyingschedule)and I further declare that I recognize C <br /> PP ( 9 Y g ° m 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 ° <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> CD <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T <br /> CD ; <br /> SIGN HERE <br /> 9 !o O <br /> (signatur ofLSHIP <br /> ing contra r) (date) <br /> ZONING ADMINISTRATOR � <br /> TOWRMITS MAY BE REQUIRED ` <br />