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Burnett County 7410 Co. Rd.K, No. 102, Siren,W154872 Office of Zoning Administrator _U ci Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> y <br /> r� p,> N <br /> OVVNER f J c°L{C�I���1,TCS n et O/Son TELEPHONE '�/ —G�4J�o -��7 O ^p <br /> m <br /> yn � <br /> MAILINGADDRESS � Li d � �-a�� (i' /T l� A I A , =&� �-1 OF <br /> PROPERTYADDRESS 1 <br /> LEGAL DESCRIPTION(see tax receipt) _�:)W - SE (to( L��I <br /> I \ <br /> DWELLING/BUILDING Ko GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ C o (� <br /> TYPE OF PERMIT(S): c <br /> ❑ n <br /> FILLING/GRADING 1 CAMPING UNIT ❑ (SUBDIVISION <. �1 <br /> STRUCTURE/ADDITION USE: lq O -O 1 . , 1 <br /> (Home/Cabin;Commercial Business; Bedroo eck;etc. N ^\ <br /> `� ) <br /> '– <br /> BUILDING CONTRACTOR: ✓YM! tf}nj PS V) <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> -iO N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p <br /> n a <br /> To Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n O :b <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m S- <br /> NORTH(N). <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 <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. I 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. N C75 <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. d o <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a 0 <br /> NEEDED. 2 <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 <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. (� oftt , / bk O,y <br /> X WIiD0Ca � m <br /> 6. 3 'am yam <br /> a m C y N o �+ <br /> 7. Z inry0 1 <br /> o T <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 m 2 : i <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize 0 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 /> DO G) : <br /> sue a permit. I further accept all liability which may be a result of the County of Burneyi on this information I am m <br /> providing in this application. 1 agree to permit county officials charged with admini t r ther <br /> authorized on to have access to the above described premises at any reasonable i e t u e n t n. m m U) <br /> o : <br /> m <br /> SIGN HERE C¢<,t! t k' !/ <br /> a : <br /> (sig lure of o ner or building contr tor) � a <br /> ZONING ADMINIde <br /> ,,, ,r, <br /> EA EA fA di N <br /> N <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING <br />