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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N O <br /> N <br /> OWNER 'reWy /t /t <br /> Al"OL)5Z TELEPHONE <br /> O • e O� <br /> MAILING ADDRESS r�' ` 4 �S'��/� SD � �x'/��/C �� � �/v ��g3'� f <br /> WT kfo CSM No, 30?.SS' ToWAv OF scams' <br /> 'PROPERTY ADDRESS 51J /_y D/' j-W /-y SZ4f1704 Z 40 T, Y41 N„^O,, /'/ /V I <br /> LEGAL DESCRIPTION(see tax receipt) S , <br /> a� Y OAK 1,>�K6 90AD ►TowNorS�r rCnCD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION N <br /> TYPE OF PERMIT(S): p p v <br /> FILLING/GRADING ❑ CAMPING <br /> 7 UNIT ❑ SUBDIVISION q❑��Rry,,t Gr��3-q8 f V a <br /> STRUCTURE/ADDITION USE: 1)6;e l s^!X 122 AT)V i L b N To C t)1 K&L PFC o <br /> (Home/Cabin; Commercial Business;Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: �`0-572-r rr <br /> • <br /> C <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 61/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O = <br /> H C <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 A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <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 <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> v 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICYF �7 o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. //�� n o <br /> CONDITIONS OF PERMIT: J ` 002 <br /> 1 ISSUANCE.DRIVEWAY <br /> MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PEIMI f��COUIM <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ONINU' i 1 <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 <br /> nAREA <br /> .,./�^ <br /> Sawnr�6. �� 3 °M0aSm <br /> 7. Z in o <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G7 A <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' m E o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is. m <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am Q� : W <br /> d . <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 CD o <br /> m m : <br /> SIGN HERE <br /> /9 TVNc A00 3 <br /> (sig=rof wner or u Ing contractor) (date) c,, a <br /> ZONING ADMINISTRATO <br /> fA di ER di� N <br /> N (TNN O O <br /> cT O (T (TOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />