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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -U 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> y g <br /> / II <br /> L � 5t a J <br /> OWNER ,� ti ,^` . �\ TELEPHONE v <br /> m <br /> II / llI <br /> MAILINGADDRESS " <br /> r�I t3"1'Q <br /> /j <br /> PROPERTY ADDRESS 3,Sgr) pe p"1�IJW (,' (�G�e ° <br /> LEGAL DESCRIPTION(see tax receipt) 1 0 S <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ElADDITION El �VIC' c o <br /> TYPE OF PERMIT(S): o c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ La' S <br /> �o.�t P <br /> STRUCTURE/ADDITIONOSE: o � <br /> (Home/Cabin; Co mercial Business; Bedroom; Deck; etc.) <n <br /> 1 m <br /> BUILDING CONTRACTOR: N-t C— C.k5� <br /> � 3 � <br /> I <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81A X 11 SHEET OF PAPER. ANY INCOMPLETE OR '3 0 cn <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> 0 0 <br /> -A N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n q <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. i7 io A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m `? <br /> NORTH(N). U <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 \ Z <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. o o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO + r" <br /> BUILDINGS,ROADS, LAKE,LOT LINES. C <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. , Iv <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS `Q 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. (_lYl ,o F <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN F. <br /> NEEDED. A <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. t <br /> t*. ° O <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ul Q <br /> ISSUANCE. Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. OOOQQQ��� ,f d <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> 4. NO SI <br /> STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> AOOOr DODO) V <br /> m a W M 0 M a f m <br /> n ° ° o a <br /> 6. <br /> >N F 3 aN F <br /> p N Cy y °_ j 3 <br /> 7. Z C vi N O t0 <br /> ,ZI <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C) c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize f 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 County of Burnett relying on this information I am (J� m o <br /> providing in this application. I agree to permit count officials charged with administering count ordinances or other — I; <br /> P 9 PP 9 P Y 9 9 Y <br /> authorized person to have acceats to the above described premises at any reasonable time for the purpose of inspection. r a <br /> Di <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) 0 <br /> ZONING ADMINISTRA OR al <br /> n v e+ <br /> �fA fAWfA� N <br /> TOWNSHIP PERMITS MAY BE <br /> REQUIRED <br /> ODATEOF <br /> LiN17-1-05- <br /> E <br /> Phmi-- 41e444-44alle 0(L ,-Wm ONE YEAR <br />