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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 o 0 <br /> ` APPLICATION FOR LAND USE PERMITS 3 <br /> - r <br /> t� !o la-.Fas- 360v <br /> OWNER K91IJ(A- M kcL '11w, Ppqrot TELEPHONE I- ?7U- 71a1' 0 <br /> m <br /> HOME ADDRESSOo�o� OEM �1�� —rVZAjL- I LAKe ago , NJ <br /> 0 <br /> EMERGENCY/FIRE NUMBER W3-7 ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) Sa f t l f ACH E D <br /> n <br /> c <br /> DWELLING/BUILDING 2 GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ rn o <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING ❑ CAMPING U DIVISI n <br /> 5. <br /> \ N <br /> STRUCTURE/ADDITION USE: N Ub <br /> (Home/Ca in;•C�mmercial Business; Bedroom; De ;et m <br /> BUILDING CONTRACTOR: � k�-Ve A-1 WET NI 1y C3 v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> w G <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> T Z <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). N0 <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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. P <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. 2` <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 0. <br /> MUST BE SIGNED AND DATED BY THE OWNER. 413OQ <br /> 0\ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Cr <br /> NEEDED. 0 <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. <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. v} <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. n 1 <br /> 5. • A 444 fd^,d hut4ymp-'-6 k3G y <br /> 6. AI a / m = Wd okcm <br /> V <br /> 7. c N (Q <br /> Cn ' m_ .CD 0 <br /> � 70 <br /> = <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ( c rn <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize A <br /> 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 w <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other to <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. -n <br /> m : <br /> CD : <br /> Fn <br /> SIGN HERE <br /> ( n ure of own wilding contr cto (d te) <br /> ZONING ADMINISTRATOR • • . • • ' fn <br /> 40444aw494� <br /> N N(r NN NU <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br /> 0000000 <br />