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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 /> N OM <br /> �� I 651-6/,31-o9�i3 ) a <br /> OWNER Sud 1 T 1 npSTELEPHONE 7�� '7 8D .�(i(C�S m T' W <br /> O <br /> HOME ADDRESS <br /> 1710061ceres hVe Roseville , Md SS//3 0 <br /> EMERGENCY/FIRE NUMBER ?a9/y ROAD NAME.& e k) Driye ~ <br /> 7our,v Ti-aa6 La Kc ) <br /> LEGAL DESCRIPTION(see tax receipt)1-of7 0$Jn Val 7 x.159,�t//o T37 1g1t1, I a <br /> ❑ a <br /> DWELLING/BUILDING GARAGE/ACCESS RY STRUCTURE I4I ADDITION ❑ PRIVYCA <br /> TYPE OF PERMIT(S): Cr ` 1 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ L <br /> &arao� �X3a 0 <br /> N. <br /> STRUCTURE/ADDITION USE: Q <br /> ii (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) m ` <br /> BUILDING CONTRACTOR: Se fpr r 1 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR m CD <br /> 3 1 �• <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0W <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). NON <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 op c <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 r� <br /> BUILDINGS,ROADS,LAKE,LOT LINES. U` <br /> 6. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. NQ(, <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR,ETC.,THE PLANS d 2 <br /> MUST BE SIGNED AND DATED BY THE OWNER. �^O ' <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Zq <br /> NEEDED. 6 `t <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o Q) <br /> CONDITIONS OF PERMIT: 4- <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. V Illy <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. (Jj <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER 1 <br /> SETBACK AREA. <br /> 5. <br /> A v <br /> W r <br /> 0 0 9 <br /> M. N <br /> 2 CL m <br /> IDS 3n Q = � <br /> 6. .5, m cu�i N o 53 <br /> 7. o! " <br /> -cn <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of myf� r G3 C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of yW n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 1 ii r^ M m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- "� y <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. 1 agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T <br /> m : <br /> CD <br /> SIGN HERE <br /> (signature of own r)(ullding contractor (date) <br /> ZONING ADMINISTRATOR <br /> N NfINNUI UI <br /> (T V1 O U1 (Jt O O <br /> O 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0000000 <br />