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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 /> OWNER q �C�` cin /LQ�A)4!� I'A m IUC ��TELEPHONE <br /> m <br /> HOME ADD RESS�j31 <P'�In►cS 14ILW- jO. �ois�A�-e, 01►l3o�.� <br /> EMERGENCY/FIRE NUMBEI /t p� ,y�) F� �7 ROAD NAME 5E 2 o <br /> 4oi .1'f30,rC.S. m., OOC81 PA3oS,,P(e0$9 /.6 �J. Coy' <br /> LEGAL DESCRIPTION (see tax receipt) SCC 7—J/0-t5, INS jt. •f d(L) W r + m <br /> O, <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE El ADDITION ❑ PRIVY 1:1 N ° <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADIN ❑ CAMPING UNIT 1:1 SUBDIVISION ❑ �' <br /> 4i <br /> STRUCTURE/ADDITION USE: l' �Jrn`� <br /> iu <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) � <br /> BUILDING CONTRACTOR: <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'h X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n <br /> m <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 /> Co <br /> 3. SHOW DIMNORTH ENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m B <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 /> S. 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 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 1 c <br /> lJ� o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <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. Q. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. V <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> m mdr, mafm <br /> 6. N 'O a N N n <br /> OLD. <br /> (D 0 � 3 <br /> Z N N <br /> 7. o Tom : A) <br /> = m : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of \ o T <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize <br /> (D m p <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- a G) <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 ap atio . I agree to permit county officials charged with administering county ordinances or other <br /> authorized person haID <br /> ve ccess t e o described premises at any reasonable time for the purpose of inspection. -n <br /> m : <br /> m <br /> SIGN HERE <br /> (sign of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />