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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 /> OWNER <br /> 1 . c <br /> R �(� �1 L bE �A v 7 r TFTELEPHONE <br /> 1 11-�� v <br /> m <br /> HOME ADDRESS R a i I� D . <br /> EMERGENCY/FIRE NUMBER R _ 2 ROAD NAME Co 7 T <br /> ov . Lt T- S <br /> LEGAL DESCRIPTIO (see tax receipt) I o -3 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ o <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADINGu❑ CAMPING UNIT ❑ SUBDIVISION ❑ 1h' <br /> STRUCTURE/ADDITION USE: FF D hi C- A D d) � r�� his � DL o Q <br /> (Home/Cabin; ommercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/z X 11 SHEET OF PAPER. ANY INCOMPLETE OR .A 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 00 ii <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. d d <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m n o <br /> NORTH(N). 3 <br /> 3. <br /> 1 3 <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. ° <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO C>- <br /> BUILDINGS,ROADS,LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. IN <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 3 -� <br /> MUST BE SIGNED AND DATED BY THE OWNER. v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q <br /> n v� <br /> NEEDED. 1 <br /> Q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o �) <br /> CONDITIONS OF PERMIT: <br /> 1 <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. G <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. / Q (1 L �- n �/ /i ` <br /> 5. — Joy /� k r rem �LCX mit ✓� I r�.V Oil � m rm ��CIm <br /> 6. 7 ��� m. onNN ? • 3 <br /> Q r✓►�1, SSk l ..V m w ii ro <br /> Z : N 1 <br /> 7. CD <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my L7 C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of n B <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- <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 pprmlt county officials charged with administering county ordinances or other (D <br /> authorized person to haVVIikiccess to the jbjdescribed premiseset any reasonable time for the purpose of inspection. T <br /> m : <br /> 3 L <br /> SIGN HERE <br /> �w <br /> Ignatur ow or In contractor) ( te) <br /> ZONING ADMINISTRATOR vw ur vi 69 <br /> N(n NN(n O <br /> M .0 Ln(A OO <br /> O 0 0 0 0 0 0 <br /> OWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />