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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o° o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N 0 <br /> O <br /> /l n <br /> OWNER ROtI JI/1L e-'- — T,); f/,ps TELEPHONE o <br /> m <br /> :° <br /> HOME ADDRESS Uq1 31 D Au�e rjrJ 2r;c, IvT S y$3 <br /> f �r � <br /> EMERGENCY/FIRE NUMBER ROAD NAME E(12 M yt L k� <br /> LEGAL DESCRIPTION(see tax receipt) s ltdcnCP <br /> DWELLING/BUILDING GARAGE/ACCESSORY ST UCTURE ❑ ADDITION ❑ PRIW ❑ � <br /> TYPE OF PERMIT(S): � <br /> FILLING/GRADING ❑ CAMPING UNIT <br /> p❑/ SUBDIVISION ElN. <br /> STRUCTURE/ADDITION USE: Polhe- d /t � ° <br /> 0 <br /> i (Home/Cabin; Commercial Business; Bedroom;/Deck;etc.) U <br /> BUILDING CONTRACTOR: IAOAA� MQ U j nti 92.40 'ar771.}F/'►4 6u Qa�t �e�crsan fii <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O = Q <br /> 7a m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 ii <br /> v Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). CO) O <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 /A Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. fl o <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. C' <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 0 C <br /> MUST BE SIGNED AND DATED BY THE OWNER. o 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q o <br /> NEEDED. ()) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o 1 <br /> CONDITIONS OF PERMIT: I <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. p . <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY �l✓ <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SE <br /> 5. BACK AREA. <br /> r� _ _ <br /> � � Or + C �Cm <br /> 6. a m C y ^CI <br /> c N 3 <br /> Z : a o (WD Ifo 4 <br /> :it <br /> 7. _ � : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of Mn <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognizem <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m v <br /> sue a permit. 1 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. I agree to permit county officials charged with administering county ordinances or other �-z m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> m : <br /> Q : <br /> SIGN HERE <br /> 41 j/00 4W <br /> (signatuy'f owner or d contractoF) (date) <br /> ZONING ADMINISTRATOR <br /> wFnwfnF»fn� <br /> N NfT NN IT U1 <br /> (T (TOfT 0100 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 00 0 0 0 0 0 <br /> Rc) 000000 <br />