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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator I o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> C <br /> OWNER <br /> ty j y�_ t 1 �A y, TELEPHONE <br /> MAILINGADDRESS F <br /> PROPERTYADDRESS �3 R`7 o <br /> C rr e 9-J.I, <br /> Z <br /> LEGAL DESCRIPTION(see tax receipt) 0j �1 _ `4 <br /> 3GcD -O 3 -DW <br /> C <br /> r J W m <br /> X71 a <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE YJ� ADDITION ❑ o <br /> TYPE OF PERMIT(S): ❑ Q D <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUB ISION a <br /> 1 r ( 0 <br /> STRUCTURE/ADDITION USE: l� o <br /> .� (Home/Cabin; Commer 'at Business; Bedroom;,Deck; etc.) � <br /> v <br /> BUILDING CONTRACTOR: <br /> ornp tx�In�4i►_ '- <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n - <br /> O <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> n a <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n ZA <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m T <br /> NORTH(N). C O <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. o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO C7BUILDINGS, ROADS, LAKE,LOT LINES. C7 <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. u t <br /> C ' o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z i <br /> CONDITIONS OF PERMIT: ° <br /> Uj <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT qj <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. f, <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 9 <br /> PERMITTED. (n <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. m cpm m Dm a0m <br /> p m C y O +� <br /> 7. Z c in O : O co -4 <br /> ID .� : m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of my =f �: O <br /> PP ( 9 Y ) y -4 C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of a C �^ <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ° to <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am m W 0 o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m ' <br /> authorized person to have access to the above described premises at any reasonable time f7WeRp, of m [ <br /> SIGN HERE j CL <br /> a E <br /> g ture o ow building contractor) (date) I o <br /> ZONING ADMINISTRATO SEP 2 <br /> A 004 <br /> � � N <br /> TOWNSHIP PERMITS MAY BE REQUIRED �Ui�NETT C()UIVTY N N W W O <br /> \J oMocn cn o <br /> 3c2�(, ��� HIS PERMIT SUALL EXPIRE ONE YEAR FROM DATE O IS�SNCrZO�ING <br /> � slop( <br /> ncule-d kl+) �0 sPP( -Ck <br /> sS GLS �' <br />