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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 /> OWNER T �r��(j ��(, TELEPHONE S/ y3 7—�3J / o uJ <br /> / ' � X53033 <br /> MAILING ADDRESS S Z`�D �� Uc� � .� f <br /> r � <br /> Jy 0 <br /> PROPERTY ADDRESS A ?y� 7 mi sc <br /> LEGAL DESCRIPTION(see tax receipt) <br /> 0 IW <br /> DWELLING/BUILDING ® GARAGE/ACCESSORY STRUCTURE El ADDITION ❑ d N 0 <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> S. <br /> STRUCTURE/ADDITION USE: ( J!'A//Y 3 L/ o <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) rn <br /> BUILDING CONTRACTOR: <br /> m <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m0 <br /> ts <br /> �1 ( <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O (D`m <br /> T n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m c Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <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 CO) w 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. , <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 IXJ <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 0 <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a <br /> NEEDED. o ) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o lfj <br /> CONDITIONS OF PERMIT: (� l <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT U <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. lz <br /> �) <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY C+ <br /> PERMITTED. r <br /> 4. NO ST UCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER lu <br /> SETBACK AREA. <br /> 5. <br /> lt7h lx�- ✓ / m an3 nDmacar: <br /> i <br /> 6. dcn am m <br /> CD <br /> � <br /> 'O N CW W 0 3 <br /> 7. Z 0 fD 0 f0 <br /> Tf m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of myt7 c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofd 0 v, <br /> CL <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o : mm <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 �' d <br /> providing in this application. I agree to permit county officials e i evrEy ordinances or other o <br /> authorized person ave access to the above described prem' y I i e he prpose o inspection. N ; o <br /> II m <br /> SIGN HERE <br /> n <br /> (signature of n ilding contras r) Ul C r�nZ I (date) <br /> ZONING ADMINISTRATOR /J� GWJ �/ r� <br /> BURNE COU T r N(�T N N O O <br /> TOWNSHIP PERMITS MAY BE R6i v o w w o 0 <br /> maxi led lb lea 6?a4dte) Q3 <br />