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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator `V 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> o <br /> 1 , �J ', () X35—�q4�0 0 <br /> OWNER TCVICXC��S©Y� _TELEPHONEl+67 r' <br /> 1 o O <br /> MAILING ADDRESS 8-e(yyt myl-l a, /,D. i t+�Me _ .m�/T � <br /> n ���111 <br /> PROPERTYADDRESS � 3Z-coa 4,aK� <br /> y <br /> LEGAL DESCRIPTION(see tax receipt) I O� O'sm ✓ <br /> DWELLING/BUILDING ❑ GARAGEIACCESSORY STRUCTURE ❑ ADDITION fn O <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING ❑ CAMPING UNIT 11SUB (VISION ❑ �' <br /> 11 rn <br /> STRUCTURE/ADDITION USE: QL rat <br /> ', <br /> / / (HoN <br /> le/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: 1A 11Lb_ <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p — <br /> ons��e <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n � <br /> T QJ Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO 8E 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 im VI <br /> NORTH(N). y 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m <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. 9 <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. ro F <br /> o � <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> 0 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT l� <br /> ISSUANCE. 'tom <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <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 /> m O D Om <br /> f m <br /> 6. m x 3 nm x a m A <br /> .a pm CN .`" o � 3 <br /> 7. <br /> o m m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m — O <br /> PP ( 9 Y ) Y Y gc' � ! C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of nN <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize ' m c m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- I m <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ,o m <br /> authorized personto ha access to the above describe premises at any reas i oTipspection. fD 'n <br /> T <br /> m D <br /> L an <br /> SIGN HERE - <br /> 4*414 <br /> (signature of owner or b Iding.contractor) 1i (date 0 <br /> ZONING ADMINISTRATOR of r I J MAY 2 1 l i <br /> _» <br /> O O N 0 W W N O <br /> TOWNSHIP PERMITS MAY BE REQt�NE� COUNTY 0 o u o v u o <br /> THIS RMIT SH LLE PI ONE YEARF 0 D TE O N� <br /> e�m (11Ci I �� wl� �ma�l%n s is-off - <br />