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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -u ci Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> Kjy, 76 3 -53 7—//59 y <br /> OWNER r Q SCO+,+, TELEPHONE In 7! J-�S�-3 Y3 7 n <br /> C' <br /> /� <br /> HOME DDRESS 40pa Q ) Z�a ) 0. hC04 - AO . ro o K l�v kl pa.► ) A O <br /> n ssy.x <br /> Ga B2h - n o " <br /> EMERGENCY/FIRE NUMBER 7/l9 ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) Cz <br /> 1 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCT E DDITION ❑ PRIVY ❑ Q 0 <br /> TYPE OF PERMIT(S): <br /> cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISIONedr <br /> n <br /> STRUCTURE/ADDITION USE: I . " 0 <br /> /Cabin; (� <br /> (Home Commerclainess; oom; ck; etc.) <br /> m <br /> BUILDING CONTRACTOR: 19;lJ d n <br /> C <br /> CD <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. T - <br /> A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> nn �Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n mo A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m cD <br /> NORTH(N). Co <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 30 <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. D� 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 GRAq N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER BUILDER,G� O TWH <br /> 9 <br /> MUST BE SIGNED AND DATED BY THE OWNER. --I /V <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIF� TION bAY.Bj DONE -y» o <br /> NEEDED. ������PV <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. BURN <br /> CONDITIONS OF PERMIT: ZION/NGN 1 <br /> COU <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT r' <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. I <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. )'4 �� `�"a)N4 ly <br /> s. 1n � � pn� <br /> UD IC— ls&Y�� �1�CYaa c 1 f m <br /> 6. b �So Sc Cs c�So, J - �o _ <br /> 11 � �. 3 n m M n � M <br /> 7. -tomic <br /> : 1 ° <br /> Z : Tom : M <br /> - (n : m <br /> I declare that this application (incl ding any accompanying schedule) has been examined by me and to the best of my n 7 C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of XJ a <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ( ID <br /> M 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 <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 /> T <br /> <D <br /> r _O m <br /> SIGN HERE <br /> (signatu f o ner or bull Ing contra r) (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />