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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Adminisrotor 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N <br /> ^ / C <br /> OWNER PcL r(�I tC� �i '� CD <br /> I(A,�j 1 TELEPHONE '��� Ip 3�1�'-7�•I �.... <br /> HOME ADDRESS 17C>Z� `i et I)w �l VCR— I_lA )GYI�r' Cc1, � 7 5�y <br /> y r <br /> 11�� u c o-c� i�t 1 � IL `0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME i <br /> �` l� w <br /> LEGAL DESCRIPTION(see tax receipt) �`W ��� �� -I _ 7 or <br /> N <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE E� ADDITION ❑ PRIVY ❑ CO o <br /> TYPE OF PERMIT(S): �, J_ a <br /> FILLING/GRADING [I CAMPING UNIT El SUBDIVISION Elbot. , 5 <br /> m <br /> STRUCTURE/ADDITION USE: 'r+ c <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) to <br /> j J (� m <br /> BUILDING CONTRACTOR: 'C..M'l_ ,-LA <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. p <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m ;o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C C) <br /> NORTH(N). fn3 <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N _C <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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q <br /> NEEDED. SO <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o II <br /> CONDITIONS OF PERMIT: <br /> � 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 <br /> ISSUANCE. ti <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. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> o vm <br /> (Dv K y I' 24W `-- <br /> AN . Osi <br /> Z N m R <br /> o '< <br /> o, : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my L7 Cr : : 10 <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of n� c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m : m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ID <br /> v <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the b e escribed premises at any reasonable time for the purpos f inspe tion. T <br /> CD <br /> CD <br /> / <br /> SIGN HERE 66 `A . <br /> (s' at of ownor Ilding contractor) date) <br /> ZONING ADMINISTRATOR <br /> M"5 <br /> N O I N NIT O I <br /> (A O 01 Vt O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED "5 0 0 0 0 0 0 <br /> 0000000 <br />