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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Adminigtrator o° $ <br /> APPLICATION FOR LAND USE PERMITS 3. r <br /> N � � <br /> N <br /> C <br /> OWNER Le OAeA v-d C.� l "1 /) TELEPHONE 7/ 5"-6 �(q—/ 7 o <br /> rr O <br /> MAILING ADDRESS A\ C vl 1 -� f ✓L <br /> 1 Y <br /> PROPERTY ADDRESS 3 /[�a�/JI �M\ ✓�( G l` )�d kc ' `J� 1 I U <br /> LEGAL DESCRIPTION(see tax receipt) I N <br /> m <br /> DWELLINGIBUILDING ❑ GARAGEIACCESSORY STRUCTURE ❑ ADDITION lr1 0 N <br /> U Q rrr'"'YY� <br /> TYPE OF PERMIT(S): n <br /> FILLINGIGRADING ❑ CAMPING UNIT ❑ SUB IVISION ❑ /,��J C y. <br /> STRUCTURE/ADDITION USE 1 <br /> (Home/Cabin; Commercial Business; Bedroo ; Deck; etc.) m <br /> BUILDING CONTRACTOR: r �2 � <br /> v <br /> M <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 y 1 <br /> C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) a <br /> '—t o z <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 y `. o <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO in \ a <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHW )OF t o <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCE 5 TO I G <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.,1 E PLANS 2 o <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o ° Ct/ <br /> NEEDED. <br /> Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> I �_ <br /> CONDITIONS OF PERMIT: 1,4 <br /> Cn 1 C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> 1 <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 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE R UIRED WATER <br /> SETBACK AREA. <br /> y516'q <br /> L (M / n// <br /> 5. '-{t;�,� ��J PLS!`1't S� /' 'tt/'M1�J�. ,y6�1.C�0 C In r D O D Oa :E m <br /> /�,�, //��/•��� Sem � F 3 6 N x a � A <br /> 6. IP.L1e 5 . 5-/yQ <br /> ve U ' 'O p N <br /> Q Z <br /> T. in <br /> »i A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and ccuracy of [ n , ; A <br /> m <br /> all Information contained in this application(including any accompanying schedule)and I further declare that1 recognize m <br /> m u,. <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining wl ether to is- 8- <br /> sue <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this infor nation I am <br /> providing in this application. I agree to permit county officials charged with ad I t r <br /> m m <br /> authorized person to have ac ass to the above described premises at any reasona i It e <br /> (p n <br /> SIGN HERE JUN I aCU I I o <br /> (sig of owner or wilding contractor) 0 : <br /> ZONING ADMINISTRATOR BURNETT CO <br /> v1 w <br /> O N N W w <br /> �fAowN <br /> W N O <br /> G O U t O U t C n U O <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING a <br /> THIS P MIT SHALL EXPIRE ONE YEAR ROM DATE OF ISSUANCE <br /> maned 4.0 I47,0r_W d rn� <br /> V <br />