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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 3. w <br /> r <br /> UT o 90 <br /> 41 <br /> ^K7-� �'7� n ` (ry�7 p C I^ <br /> OWNER )/o t L� I'"7'/l L S Ar O ry? TELEPHONE 866 - Q ! /6 n <br /> MAILINGADDRESS 28016 Zone 'Ft -,7,e Rid WP.d S /er W1 ^' / 8 91..E v <br /> � r fD <br /> PROPERTYADDRESS 28016 Lone Ttae 9Q "Velxke- WIT <br /> LEGAL DESCRIPTION(see tax receipt) j 0 T b'% g h- 136,k�8� Tn <br /> w, Tw o+7 a (21) `SCD <br /> fir <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION <br /> TYPE OF PERMIT(S): `v <br /> FILLING//GGRRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITIONUSE: G O 1<fl /'f0/'J Li f!i -�Ci Roo.,-1 Be / <br /> / (Home/Cabin; C mercial Business;Bedroom; Deck;etc.) (n 1 G <br /> BUILDING CONTRACTOR: We C-5-0 a CO/7S-7rate <br /> � J � <br /> MS <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. 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m AS <br /> NORTH(N). CA 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. C� <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. SLi <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. 5 -- <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> V I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o Jj <br /> CONDITIONS OF PERMIT: ?T <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT O <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. O <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 /> X W 0CDaf m <br /> 6. 2 3n2Za- <br /> m C N n 0 = 3 <br /> 7. 0 <br /> O T G <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 a ^ 5 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize I ( C c'5 m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m :J <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 d <br /> providing in this application. I agree to permit county officials charged with administerin on er <br /> authorized person to have access to the ab ve described premises at any reasonabl I t' n. T fD o <br /> Ln <br /> //O_ J -I � <br /> SIGN HERE 'KJ0-1/ <br /> ? n <br /> signat <br /> ur <br /> e of owner or building contractor) r� (d i <br /> ZONING ADMINISTRATOR V ' O � LO4 <br /> i rn 3fu ai-31� <br /> ?URNETT COUNTY G N N N o <br /> N O U N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING <br /> V <br /> 1 <br />