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Burnett County 7410 Co. Rd. K, No. 10:1, Siren,WI 54872 Office of Zoning Administrator - o o <br /> APPLICATION FOR LAND USE PERMITS 3 - <br /> r <br /> UT O <br /> N <br /> JCL <br /> OWNER C TELEPHONE o <br /> �6 �a O <br /> HOME ADDRESS G JQ <br /> r m <br /> 0 <br /> EMERGENCY/FIRE NUMBER 39g3 ROAD NAME ? v� R� t <br /> LEGAL DESCRIPTION(see tax receipt) �O T. $LC /S <br /> DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ cn 0M <br /> TYPE OF PERMIT(S): Q/ a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ t '� <br /> ytJl <br /> STRUCTURE/ADDITION USE: 0 <br /> Horne/Cabin; Commercial Business; Bedroom, eck; etc.) rn <br /> BUILDING CONTRACTOR: � � S W MCD <br /> � <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/z X 11 SHEET OF PAPER. ANY INCOMOLETE Olj 9� 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED O V�/ U T <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 6 �„}� O o C <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW <br /> BU D INDICATE m <br /> C <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.Al <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. O <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED B AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR,ETC.,THE PLANS ( hh . <br /> MUST BE SIGNED AND DATED BY THE DINNER. o a 11 <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WID H REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. �• 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 <br /> PERMITTED. j n <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER "I <br /> SETBACK AREA. <br /> 5. 0 � Cf=. mWa -a- <br /> (D <br /> 6. OLD. �pcN � o � 3 <br /> Z : N N O O t0 <br /> 7. o _ Tn m <br /> N <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G> A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize tD Ei. CD mm <br /> that this information I am providing will be re led upon by the County of Burnett Wisconsin in determining whether to is- <br /> sue a permit. I further accept all liability whi h may be a result of the County of Burnett relying on this information I am <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the abov 3 described premises at any reasonable time for the purpose of inspection. m m <br /> CD <br /> CD <br /> SIGN HERE '- a3 a 2., u <br /> (a I' at a of Or or building contractor) (date) . .X' <br /> ZONING ADMINISTRATOR /r'1 iel xx <br /> TOWNS IP PERMITS MAY BE REQUIRED �^11 Ci <br />