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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator T c� z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r r`• <br /> y � r <br /> CDOWNER 1,' TELEPHONE <br /> HOME ADDRESS 14A z e L V1�Q x- tutu �se( l ` O <br /> a <br /> EMERGENCY/FIRE NUMBER L \�' V i� ROAD NAM TrA <br /> JF <br /> LEGAL DESCRIPTION (see tax receipt) y,� 1y -Sc e-- �.- <br /> 0 f <br /> DWELLING/BUILDING L$ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a ram-• <br /> , ll / ` , `, T. <br /> (1 <br /> STRUCTURE/ADDITION USE: �7 u-AAe- C1 x � (YVn -{ <br /> (Home/Cabin; Commercial usiness; Bedroom; Deck; etc.) I <br /> BUILDING CONTRACTOR: I\ 4i1. C%f p(AJ <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR CD m 3`n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> 2 Up- <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O (D <br /> M —'-- z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m �o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C 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 ` T Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO B IN , I <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUIL �Aro <br /> PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. ,. J o C'' <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE� RIFICOMPAY BE DONE <br /> NEEDED. A�"� S ��l/�� M. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. �vRN�7`�- _ / z <br /> CONDITIONS OF PERMIT: ZQNN�C 0ji/V / o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT C <br /> \ � U <br /> ISSUANCE. LA2. 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 /> 5. <br /> CDcN w o_ g 9 <br /> 7. <br /> -oil-1 e-as-1o3 _c N T , <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy ofCL <br /> m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CD <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 _ °1 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other co <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. CD <br /> -n <br /> fD <br /> t- (D <br /> SIGN HERE <br /> (signature of r or building contrac r) (date) <br /> ZONING ADMINISTRATOR M1 �11 <br /> TOWNSHIP PERMITS MAY BE REQUIRED �L <br />