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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o° o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> v <br /> /^' im` ESS�4� <br /> OWNER AT T A 2� ALV L/O� �O 0-'o Ot <br /> TELEPHONE <br /> 1 L <br /> HOME ADDRESS 7 7�a C� Br 03�Q U �t/ �/1-l�/ V 'r`!f <br /> EMERGENCY/FIRE NUMBER /?, C? ROAD NAME �revgp e e �i o <br /> T '�' Cfl <br /> LEGAL DESCRIPTION (see tax receipt) �_c <br /> o <br /> TYPE OF PERMIT(S): <br /> DWELLING/BUILDING [I <br /> GARAGE/ACCESSORY STRUCTURE Ix ADDITION ElPRIVY [Io <br /> FILLING/GRADING ❑ CAMPING UNIT ❑/ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: 1-/9 y/� /) A� / c2elk k ZI <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> LF- <br /> BUILDING CONTRACTOR: SEC <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR n <br /> 3. <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> � y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) Om n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <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 3 <br /> 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. O <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR,ETC.,THE PLANS o <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN r <br /> NEEDED. 2 S� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o OY <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <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 /> 5. X 'V0r- Ov <br /> Clu m o. m <br /> 'o mCm o = 7, <br /> 7 o MW <br /> . <br /> C,: m <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 of o <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m m <br /> m <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 Counter of Burnett relying on this information I am <br /> providing in this application. I agree to rt unt ials charged; i in ces or other m <br /> authorized person to have acces o t above de ed pre ises at an " t' r p inspection. -n <br /> m : <br /> CD : <br /> SIGN HERE <br /> (s nature of owner or building contractor) 4--ju <br /> N 2 (d <br /> r'. ff <br /> ZONING ADMINISTRATOR COLIN 17 <br /> ryY�J ' <br /> vlinEnEnFnrnw`� <br /> N Nf7i NNN (T <br /> AgNING <br /> �o 000000 <br /> TOWNSHIP PERMITS MAY BE REQUIR No 0 0 0 0 0 0 <br /> l., <br />