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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 /> c <br /> n <br /> OWNER V�� �� �,R Q (}camv� TELEPHONE <br /> U2 <br /> o <br /> Iy� O <br /> HOME ADDRESS 3U �✓f} Sou„V"H-S��t..� - �y.�v,� Scj7O�S r CD <br /> � �Q o <br /> EMERGENCY/FIRE NUMBER ag�1g ROAD NAME SCYIrC& <br /> LEGAL DESCRIPTION(see tax receipt) <br /> IpI I ✓ f p a�j�► �� ' c <br /> DWELLING/BUILDING Ipl GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ m 0. <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADIN�j 1:1CAPING UNIT ❑/ SUBDIVISIONT. <br /> ❑ / 5• <br /> STRUCTURE/ADDITION USE: 1Pa �) ��P�A�I�ta ^' <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) ( �f <br /> BUILDING CONTRACTOR:,�r�_ —1.. 'CC E <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> O io <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) T o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. t7 m z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE im ° a n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> 9 <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 r <br /> BUILDINGS,ROADS,LAKE,LOT LINES. (/r <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS ` <br /> MUST BE SIGNED AND DATED BY THE OWNER. J I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Cr <br /> NEEDED. I <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. <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 /> 6. ��7. �J �� fD o n tNo 7 9 x <br /> 5 -q9 OiK y i; : 3 <br /> Q er Z N <br /> l/V_, I O A <br /> -C': m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of myL3 C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m 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 C: m E <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other E m E E <br /> authorized person to have access above described premises at any reasonable time for the purpose of inspection. m <br /> m : <br /> SIGN HERE <br /> islo-natU36Pfowner orbuilding ntactor) (date) ,n <br /> ZONING ADMINISTRATOR ' <br /> �4W <br /> N N (liNN V1 Gn <br /> N (JI O (11 (T O O <br /> O 0 0 0 0 0 0 <br /> OWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />