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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 O0 <br /> N <br /> C <br /> / d <br /> OWNER ` ,g /� U I'� S TELEPHONE 745 <br /> HOME ADDRESS / t ' C r yc IU Lam/ r--kA W I J 7 <br /> 0 <br /> EMERGENCY/FIRE NUMBER 3 y G ROAD NAME s�� /rk4 ~ <br /> n A <br /> LEGAL DESCRIPTION(see tax receipt) l 1— / / �� L 1 Q�F <br /> i m <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <; <br /> / N <br /> STRUCTURE/ADDITION USE: CI 5/►-j <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) Cn <br /> BUILDING CONTRACTOR: OOd/L-w��� l/ ��t I�YnS - �Ir^�/ /✓i/S/N <br /> m <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/s X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) OT a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m v <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE CD <br /> N o <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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. 0 <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. " P (1 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 0 C- <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS Q t� <br /> MUST BE SIGNED AND DATED BY THE OWNER. `Z, w 0 <br /> � �(� 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ON �� A�BEB6 WHEN q <br /> NEEDED. NOV ? (.VVI Z (^ N <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 1 0 <br /> CONDITIONS OF PERMIT: CI <br /> SURNETT COUNTY <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DA OF PANG <br /> ISSUANCE. LVIV C� <br /> i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY V <br /> PERMITTED. iJ 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> TB CK AREA. // / .t <br /> 5. •J• + Perm! {'. 7/l�� ie Neuf sTruc�a�e W� 1 e& ;o <br /> I IONO J CD W 0 ODO '0 <br /> Q ed 0 3 cODOn � m <br /> 6. t t lYe Sc'l Aat/bs /a '4e PrIva e D y N o_ - 3_ <br /> e e k ce a-j r-h i nk m Y� y <br /> nn � / N (D O . 0 <br /> 7. �rlUa rev b2 helac� if11�i�A1 r 0t rte ` rSuanCe • T ` ' M <br /> = N O <br /> I declare that this application (including any accompanying schedule) s been exa inad by me and to the best of my 0 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 1 further declare that I recognize fD m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 a ° <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 /> CD : <br /> / - - v <br /> SIGN HERE () <br /> (signatureof er o b Id r (date) <br /> ZONING ADMINISTRATOR <br /> Q <br /> TO 4SHIP PERMITS MAY BE REQUIRED / -0 I A <br />