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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872Office of 0 7 <br /> Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS Q 0 0 <br /> 3 4 <br /> OWNER OS 1 4!��y/ <br /> a V4er TELEPHONE 6,5 �/7 1 <br /> 1, r <br /> HOME ADDRESS 7 3 /, / (/ ( >/�S �J ,( ,A2 �� 00 <br /> - <br /> `'v T l�Y / 7 <br /> qq 0 <br /> EMERGENCY/FIRENUMBER r <br /> !D 2- ROAD NAMED Z 44 t <br /> LEGAL DESCRIPTION(see tax receipt) {� C�� �/ 70�7Q c �' (� \ Cnn' <br /> T / ) o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ rn c <br /> c � <br /> FILLING/GRADING PING UNIT ❑ SUBDIVISION ❑ <br /> CL <br /> STRUCTURE/ADDITION USE: q, / X a� S. <br /> (Home/Cabin, Uommercial Business; Bedroom;Dec ;etc.) ' N <br /> / d (n o <br /> BUILDING CONTRACTOR: 5 Qom/ 1=1 <br /> lir <br /> 71 <br /> A PLCT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR I <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T 3, <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWIN • (AERIAL OR TOP VIEW) `" 0 <br /> c <br /> O ii <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n0 ? <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <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. zJ <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO P <br /> BUILDINGS, ROADS,LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 5. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS I <br /> MUST BE SIGNED AND DATED BY THE OWNER. of <br /> VOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN o <br /> NEEDED. <br /> 'HIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c O <br /> eQNDITIONS OF PERMIT: <br /> DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. rr''tt <br /> REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. W <br /> NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> ETBACK AREA. Jj I 1 0 <br /> fo � � aa0 9z <br /> fia r5sue, i <br /> declare that this application (including any accompanying schedule) has been examined by me and to the best of my y m <br /> nowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of � : m " : C <br /> II information contained in this application(including any accompanying schedule)and I further declare that I recognize 1 C m m <br /> iat this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> ue 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 /> roviding in this application. I agree to permit county officials charged with administering county ordinances or other <br /> CD <br /> uthorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> r m <br /> IGN HERE <br /> cn <br /> (sig ure of owner or buil g contractor) ( (date) <br /> ONING ADMINISTRATOR , /6 - La O <br /> viFnwv+cefnin <br /> N N N N N <br /> v, o v, u, P P <br /> TOWNSHIP PERMITS MAY BE REQUIR u, p c <br /> 0000000 <br /> 0000000 <br />