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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator vCy�C) " 1 z <br /> APPLICATION FOR LAND USE PERMITS 3 (°� <br /> 0 <br /> 0 <br /> x �p �{f N <br /> OWNER i �1 1 G�W1 �C Q� �I{')C-f QQr, TELEPHONE�]1 —a qc a pq�— n <br /> I m <br /> HOME ADDRESS �a // �7 416.6 � <br /> f-ri<ufi1 cri ttk It a Nv ct 3r. ::Tn.Fp LG K� U/ o <br /> EMERGENCY/FIRE NUMBER �� �� � ROAD NAME ef fU�Hoad <br /> LEGAL DESCRIPTION(see tax receipt) w t ) j r y <br /> � —�, m <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY. ❑ y o <br /> �\ TYPE OF PERMIT(S): /qO /�� c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ i / / 7. Cr <br /> STRUCTURE/ADDITION USE: C` -" <br /> o' <br /> m /Cabin; Commercial Business; Bedroom; Deck; etc.) Cn <br /> BUILDING CONTRACTOR: <br /> l <br /> fir <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 11 3 ( ' <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -pY1 <br /> 71 y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O G pa <br /> n o. <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Z <br /> 0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m I <br /> NORTH(N). C 0 <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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ckz Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO ' e <br /> BUILDINGS, ROADS,LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <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. I -3. <br /> c <br /> �o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. Cr o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. p _ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 'tel <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 �1 <br /> SETBACK AREA. <br /> 5 <br /> 6. m 3 m <br /> 7. a : N CL M L1 <br /> C N y c 3 <br /> Z : N N <br /> o � <br /> Cn: i m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my A <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 1 further declare that I recognize �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 m <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 /> CD <br /> SIGN HERE J Z fry <br /> (slIOWNSHIP <br /> owner or Idi nt cctor)) ,, (date) <br /> ZONING ADMINIS ATOR na�ai �"v/ <br /> �jrNi+ �oaSNi+ oo <br /> PERMITS MAY BE REQUIRED f`�0000000 <br />