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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 /> m O <br /> N <br /> C <br /> OWNER a <br /> TELEPHONE7 �a5�l(V tiioe(A� ro�P �eyylajl <br /> v <br /> O <br /> MAILING ADDRESS d(/ / Xa4 Zp . oe*- 61C VirJP3 <br /> f <br /> r M <br /> 0 <br /> PROPERTY ADDRESS _`Q, j,*1 cP <br /> LEGAL DESCRIPTION(see tax receipt) , 1 3 m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ 1 C 0 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITIONUSE: �-AIV"C4-fin <br /> ( me/Cabin;Commercial Business; Bedroom; Deck;etc.) rn 0 _ <br /> BUILDING CONTRACTOR: Se d <br /> Q <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 71 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. TO <br /> M rr^^ll <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) S"P O \J <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n _ A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m Q <br /> NORTH(N). Co <br /> to 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <br /> CENTERLINE OF ROAD,(C)BUILDINGS)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 9 <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DIF),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. F <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN S <br /> NEEDED. 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z c <br /> 0 <br /> CONDITIONS OF PERMIT: <br /> , <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 /> SETBACK AREA. <br /> 5. (1.A.Y W �IEbS �-}— <br /> g Q m oOid00itCocCrn <br /> 6. '� 3 nm F;'`F—_° M <br /> o m 0 C : o 3 <br /> 7. Z m 0 0� =1 <br /> 9 -n' M <br /> I declare that this application(including any accompanying schedule) has been examined by me and to the best of my C)c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a 0 N <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize (D E o ; M <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 w <br /> providing in this application. I agree to d <br /> p g pp g permit county officials charged with administering county ordinances or other : o <br /> authorized pennon to hWq access to the abo ascribed premises at any reasonable time for the purp a of inspection. 1° c <br /> m m <br /> SIGN HERE d' o <br /> (sig t e of ner or ulldi contractor) 4date) 1 <br /> ZONING ADMINISTRATOR UV <br /> E E Esq cn <br /> Ibs <br /> N0 N NOO <br /> (TO(T Ut 00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />