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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. <br /> r- <br /> y O <br /> 41 <br /> CD <br /> d y <br /> OWNER Ly f��� TELEPHONE <br /> 7 v <br /> /, d <br /> MAILING ADDRESS �L1�Itf DaIl(ie JQhjfS� i,?,jA ' <br /> PROPERTY ADDRESS pJL�Q�� ✓r�G/ �TjfS�i! /�d�� <br /> LEGAL DESCRIPTION(see tax receipt) / 38- m <br /> c� <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION �` l/> <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> ��O/NG efe " ooi,-► ' 4U�9L fia-f/!�/�r f ilrlo�CSC ' <br /> STRUCTURE/ADDITION USE: / p . <br /> (Home/Cabin; C easiness;Bedroom;Dedk,6tc.) U) r <br /> s' ^^ m <br /> BUILDING CONTRACTOR: � CD <br /> �jt�/Q�CJ ' <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> �l N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> In <br /> Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <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 <br /> v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER K(OHWM)OF Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Z o <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND;I�I� <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED ILLED. ITHEA <br /> N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CON TOR, TC., � 4� <br /> MUST BE SIGNED AND DATED BY THE OWNER. 'CUs l gn,, 111 f <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATIONS F�'ONE WH&9,p ° <br /> NEEDED. �'���� �� �/ C <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. CNING N o <br /> CONDITIONS OF PERMIT: I <br /> 1 <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 �U <br /> PERMITTED. (� <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER V1 <br /> SETBACK ARA. qUj <br /> 5. Q/t.(GtQ'L �s / <br /> l �j �j m d iu 0 v a v v <br /> 6. allUri n(C�.L!f /✓�� J�//^'-LC / �' nm xQ.- �°— <br /> / ' <br /> CD C y N 0 3 <br /> 7. Z N o O -� <br /> CD <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my !1 ' 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 /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize { �� (D 0 0 <br /> N" <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 m <br /> providing In this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m o <br /> CD <br /> CD m' <br /> SIGN HERE <br /> (sig tur of ow or �cto') <br /> (date) a <br /> �Q� ' ' <br /> ZONING ADMINISTRATOR <br /> f»en <br /> EA A EN <br /> A0 <br /> N LN O O <br /> Ol 0 N O N N N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />