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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> ~ s� <br /> N <br /> �j ,ateN <br /> OWNER �"�� �t`�VIS'i TELEPHONE <br /> "&A 7Ai 6�633V o � O <br /> HOME ADDRESS 3`j(cp G(t�2Slki 1YV N (<AK�fAL� ' ora j�Z O <br /> EMERGENCY/FIRE NUMBER a'�ri�z/3 ROAD NAME�, �p1la�s 2t vF.,Z 2/� � <br /> LEGAL DESCRIPTION(see tax receipt) <br /> See 7 y Lfa N 2 16w R40U/'J'5- i vtQ <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE X ADDITION ❑ PRIW ❑ 'V� c ~ <br /> TYPE OF PERMIT(S): 0 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> 3 6 (�Pv-t� L y. <br /> STRUCTURE/ADDITION USE: C]�IZt�CTE -3R x o <br /> (Home/Cabin, Commercial Business; Bedroom; Deck;etc.) Cl) <br /> BUILDING CONTRACTOR: <br /> v � <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 91 <br /> 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> O H <br /> DIRECTIONS FOR PLOT PLAN DRAWIN • (AERIAL OR TOP VIEW) !/I <br /> n F C <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T v Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). a �' Q <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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. c <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. S <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ,/� <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. i <br /> o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q o, <br /> NEEDED. w <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <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. QL <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 /> A <br /> 6. ' m� m <br /> vCUsr r. <br /> 7. Z m Co. o : (P i <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my iA <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m E C <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize C m :CDm <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to is- p <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am <br /> providing application. 9 P county <br /> p gin this a licatian. I agree to permit coun officials charged with administering county ordinances or other (� ; m i <br /> authorized person to have access to a e des ribed premises at any reasonable time for the purpose of inspection. <br /> m <br /> CD <br /> SIGN HERE d+ <br /> (signature owner uilding con a tor) (date) <br /> ZONING ADMINISTRATOR <br /> N N(nNNN (7� <br /> �37`JI �nvOUNOO <br /> WNSHIP PERMITS MAY BE REQUIRED O 0 0 0 0 0 0 0 <br />