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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator -U G) Z <br /> APPLICATION FOR LAND USE PERMITS 3 0 '� <br /> r <br /> �X/ <br /> I'� <br /> w <br /> CD <br /> OWNER <br /> le Y" TELEPHONE �J J 1 C1 C�r� o <br /> t p(� Qin, ' A �- p d <br /> HOME ADDRESS �wC? Too/<6'5 k, !�/ �2P,� k <br /> CD <br /> 0 <br /> EMERGENCY/FIRE NUMBER SQ,rnQ ROAD NAME Q° <br /> l <br /> LEGAL DESCRIPTION(see tax receipt) PCS4;,)q- 6TC'1 .0 <br /> yo, l C Cl) <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITIONK PRIVY ❑ N 0 <br /> TYPE OF PERMIT(S): <br /> v <br /> FILLING/GRADING ❑ CAM G UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: <br /> dowte <br /> ome/Cabin; Commercial Bus i ss; C <br /> rBedroom; Deck;etc.) ° <br /> BUILDING CONTRACTOR: I a,e 1/ tU e 11 N T <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> � N O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m -9 <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m W <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. Cy <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N 9 J <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,C CTOR, ETC.,THE PLANS QJ Op <br /> MUST BE SIGNED AND DATED BY THE OWNER. I 1 <br /> O � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VER ICATIO 4r/ <br /> HENNEEDED. zr/ , <br /> 2 y� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT:1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PE " r c NO <br /> , <br /> ISSUANCE. h/�N <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. G \_ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY C <br /> PERMITTED. r !� <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER tv <br /> SETBACK AREA.\ r <br /> 5. L-1 - 6WU - / 0 M. W W0Caf m <br /> 7. : T <br /> _ �: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of n T <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize PP ( 9 Y ) 9 `D � p <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 have access to the above described premises at any reasonable time for the purpose of inspection. T <br /> m : <br /> m <br /> SIGN HERE <br /> (signatu a of owne building contr V or) (date) <br /> ZONING ADMINISTRATOR �\ f.�.y1 tlit f <br /> G <br /> TOWNSHIP PERMITS MAY BE REQUIRED C' <br />