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Burnett County 7410 Go. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0Q Z <br /> APPLICATION FOR LAND USE PERMITS 3. n <br /> OWNER /Gl7.gGs� T � l " LGrT TELEPHONE <br /> MAILING ADDRESS �� L�/CL'LL/2C G,i� ��� ` O <br /> PROPERTYADDRESS 311 Y 9 /�✓c.F �� Su,, ///W^ s!� ,' r�. o <br /> y W <br /> LEGAL DESCRIPTION(see tax receipt) ��/ C sM L/ / 3 <br /> 2^ � <br /> r� J —4t- M <br /> DWELLING/BUILDING Ot GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ 0 <br /> TYPE OF PERMIT(S): ❑ �a X 33 CL. <br /> FILLING RADING 1:1 CAMPING UNIT El SUBDIVISION �j�,, <br /> STRUCTURE/ADDITION USE6-111� ���/ ✓ I-e /it I <br /> 1,e (Home/Cabin; Commercial Biness;Bedro'om;^Deck;etc.) uJ/n NBUILDING CONTRACTOR: 1� X I SV[X��l lJv/t/l ` M <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLET T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. j I V Jey , . -n 3 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 1 } v O <br /> TZ \ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO CALF, n o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C <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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. I V' o <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO su <br /> BUILDINGS,ROADS,LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I o Q <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. CNC o <br /> _4o 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITH I WHEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 1 M,�r o <br /> CONDITIONS OFPERMIT: a r <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DA?W"-T C> <br /> ISSUANCE. T� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG S�COON r / <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY "6 <br /> PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. lA <br /> 6. m d�`0gg:E M <br /> )0 Sam %2. M <br /> "O N <br /> m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m – A <br /> PP (� 9 Y ) Y Y <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d in c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize C o 0 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- SCS <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 v <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 for the purpose of inspection. m � <br /> - o : <br /> CD <br /> SIGN HERE <br /> (sl atur of owner or bulLdft c ractor) (date) <br /> ZONING ADMINISTRATOR ' <br /> fAMdl EA � N <br /> 0O (NT OO <br /> TOWNSHIP PERMITS MAY BE REQUIRED PSI (� <br />