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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator �'a 0 ro <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> 0 <br /> y O <br /> OWNER �Ie/Allj/1 /7trfP/L� Rab/nc TELEPHONE ,7iS 3 r9 7�3/a m <br /> HOME ADDRESS S 7 ( �4�P ll� A,1 <br /> m <br /> �p o <br /> EMERGENCY/FIRE NUMBER �/ / ROAD NAME Pke <br /> LEGAL DESCRIPTION(see tax receipt) L' V u, <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION PRIVY ❑ y o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ S DIVISION ❑ a <br /> Q� 5. <br /> STRUCTURE/ADDITION USE: SG4?SDh Qi`D & <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: AdA-t I-O.I;s). �ar1� �y�1—SSg7 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T r: <br /> �•/�• <br /> DIRECTIONS FOR PLOT PLAN DRAWING: SGL 0 <br /> (AERIAL OR TOP VIEW) !' p m <br /> .O <br /> r aY/ n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCAL n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 9 <br /> NORTH(N). c 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. c <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. Q <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 N <br /> MUST BE SIGNED AND DATED BY THE OWNER. c <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN W 0 <br /> NEEDED. CrT <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> CONDITIONS OF PERMIT: P <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. F� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. I <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 1 J <br /> PERMITTED. -I <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> 5. <br /> SETBACK AREA. <br /> ,p may/w� /1 ����/ tv <br /> 6. CCD M. M M m m <br /> v MCrn `" o' � 3 <br /> 7. <br /> ON e1��s �i5 l sbAv� �m SSU Z <br /> r P : <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Q : p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m c <br /> all information contained in this application(including any accompanying schedule)and I further declare that Irecognize C m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- p <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 d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> M <br /> SIGN HERE <br /> S- y- tri <br /> slg lure of ner r ding contractor) (date) <br /> ZONING ADMINISTRATOR <br /> v+tnwcn cw tn� <br /> N N fT N N U1 U1 <br /> fl1 VtOf71 U1 OO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />