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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 /> N o <br /> N <br /> OWNER (1 `'LJJ r12 ��1 Q I��i� TELEPHONE 7 <br /> v <br /> v <br /> ! o <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS Cj{4rr1� r 1 <br /> 8 /7u.' RFs <br /> LEGAL DESCRIPTION(see tax receipt) _ <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION X w !n <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTUREIADDITIONUSE: 1 ffC1 /�f XlQ4'�r({j (gyp]�J��jUyl�Sin 0 <br /> �. �. <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) (n <br /> m <br /> BUILDING CONTRACTOR: CD <br /> m <br /> v <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. "n - <br /> O <br /> I;b N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m 0x <br /> n n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 3 A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 9 <br /> NORTH(N). <br /> 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)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF ` Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. o <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. d 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. In o ) <br /> / O � (� <br /> 'NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERI7' 4061 <br /> �rtJ�j�#PQQNE WHEN � °, 1(J <br /> NEEDED.THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT:1RIVEW E MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERIL) i I O , <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE���Co <br /> J � Y�) <br /> 3 PERMITTED.NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 20N1N147y a <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> CD W 0 M n f M <br /> 6. 3 o m xnm M <br /> (gyp C y N O 3 <br /> 7. Z w o 1 <br /> m <br /> 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 <br /> O N <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o : 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 I am m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> - o <br /> C / m D <br /> SIGN HERE <br /> (s natur o o/ynerr or building ntracto/rr)) ' (date) \ o <br /> ZONING ADMINISTRATOR / 1 �'N G' <br /> rnLh��c) <br /> n �J N N N N O <br /> TOWNSHIP PERMITS MAY BE REQUIRE Sem GS�'� `n o N 0 0 <br />