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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator T o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> 0 <br /> N ^ ' <br /> N W <br /> C <br /> l I _eJ 1 D 1 <br /> OWNER C h('l S �. R�y H d eAard TELEPHONE o <br /> 1C <br /> ,I �} � O <br /> /(. <br /> MAILINGADDRESS 3�$ West 234,5fw f/QA) _55033 <br /> --Io <br /> PROPERTY ADDRESS y J 5 a T4- /I Aen DnV(� 11)444 6-fX W/ l C> m <br /> LEGAL DESCRIPTION(see tax receipt) ✓ee rA 71.s 'e <br /> . C lo , /5- r, al 10 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ® ° <br /> TYPE OF PERMIT(S): cr <br /> FILLING/GRADING ❑ CAMPING UNIT 1:1 SUBDIVISION ❑ <L <br /> STRUCTURE/ADDITIONUSE: Sed vor1 <br /> (Home/Cabin,Commercial Business;Bedroom; Deck;etc.) cn <br /> BUILDING CONTRACTOR: TrCnSft- (0cuC1jd/) <br /> -o <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> ;a N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n <br /> T <br /> � 0 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE Aa <br /> NORTH(N). y O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> v <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. l 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. 91 <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. E <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° <br /> NEEDED. � <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: (� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT v <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 /> ISTBACK AREA. <br /> CD v d 0 O a f m <br /> 6. C . 3 'ac Ox <br /> a m C y N O 3 <br /> 7. Z N 1 O : O <br /> O O -� <br /> T G TJ <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �j C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CD O mo <br /> that this information 1 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 m <br /> providing in this application. I agree to permit county officials chalk,iW hti acounty ordinances or other <br /> authorized person to have access to the above described premises alab. purpose of inspection. ° o <br /> w (D m <br /> SIGN HERE /-4 n <br /> ( ' a of owner or building c /tor) l - -J (date) <br /> ZONING ADMINISTRATOR 7'� COUNTY 7�g <br /> 1 I 0 0 0 I V l t EA d/fA fA�N <br /> N U N N O O <br /> (T O Ut (T O O <br /> OWNSHIP PERMITS MAY BE RE?Q <br />