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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 35T 0. <br /> OWNER !(//✓1(!l /I �/ L7/L✓LfU'� /TELFpHONE <br /> MAILING ADDRESS 3! / �'Ijc"•�rUyry /S "et C�"/ �,(�— 5q D O�ll <br /> f <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) 4& 3 (2.5m ✓3 P ao G . 19 T. ff�J R.l cn <br /> M <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION to 0 <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT El SUBDIVISION ❑ CL <br /> Q < <br /> STRUCTURE/ADDITION USE: J Cell e G/f 4'--"0b G 40 X o <br /> (Home/Cabin; Commercial Business;Bedroom; Deck;etc.) rn <br /> W <br /> 2. <br /> BUILDING CONTRACTOR: io <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. OT " O <br /> M m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <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 <br /> NORTH(N). co Q ` 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 <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 BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS 0 COO <br /> 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o f <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN "» 0 1 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o 1� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT C> <br /> ISSUANCE. C> 1 lll���lll <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. rr�� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY \l <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. 6 �F - nut �00d'� �ildr cCLt¢Q <br /> 6. AJC I � CI Yl 6l 1 1 t�-M L." "�'• 3 a m x P_ m <br /> /J 'O ry C <br /> 7. Z in ry 0 O <br /> O -n 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 (� �` m n v. <br /> W: CD to : m <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognze m � o : m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- � 0 <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 m <br /> V <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m c <br /> CD r <br /> SIGN HERE "� v <br /> (sl ture of o r building contra o) )date) ~ ' a <br /> ZONING ADMINISTRATOR " /� G'�rLJ <br /> to fA EA fA N <br /> N O1 N N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED IU 9602 C� v " " 0 0 <br /> iz960 <br />