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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N O <br /> N <br /> CD <br /> OWNER J EQA wI I, ( ) Z9o <br /> m <br /> MAILINGADDRESS a 3 oto ry r <br /> r m <br /> 0 <br /> PROPERTY ADDRESS L_4,0 t- <br /> LEGAL DESCRIPTION(see tax receipt) -/ S <br /> 2 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION t Cn <br /> TYPE OF PERMIT(S): � <br /> FILLING/GRADING 1:1 CAMPING UNIT ❑ SUBDIVISION ❑ ,� / J ,Q�) QQ� a <br /> STRUCTURE/ADDITION USE: 1�✓�) U�(a a�(,t, a �!x3 a�-fP2X�,(�-��„ r/ L (1� <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) (n <br /> d <br /> BUILDING CONTRACTOR: r + d <br /> 1 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'h X 17 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> A N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) -n n (1 <br /> tet " <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). o <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. P <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. o <br /> Q � � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ^» o <br /> NEEDED. 2 <br /> I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P Q , <br /> � N <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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 REQUIRED WATER <br /> ETBACK AREA. _yl <br /> A 0 r D O � <br /> m W d 0 N <br /> 6. 3 CLCD X m <br /> v 'a <br /> -5' <br /> 7. Z rn N o <br /> o T M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) c c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m n v, <br /> CL u, <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize m $ : 0 . 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 d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized per :to have access to the above described premises ata t >se of inspection. -nm o <br /> CD <br /> SIGN HERE "' <br /> a : <br /> (signatur wner o;building contractil at ) <br /> J 2 <br /> ZONING ADMINISTRATOR v <br /> COUNTY <br /> TOWNSHIP PERMITS MAY BE REt.1U1ING <br />