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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o° o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> ° o <br /> r (D -F- <br /> OWNER <br /> �..r h y � I / l 4 v►'!S TELEPHONE <br /> 0 <br /> MAILING ADDRESS -4 C5 <br /> i T M <br /> o <br /> PROPERTY ADDRESS <br /> I(� Ll_l�� 11r100 4mLL)r <br /> LEGAL DESCRIPTION(see tax receipt) aP / �3 ` �/06_0 j <br /> DWELLING/BUILDING ❑ GAA/RAGE/ACCESSORY STRUCTURE V ADDITION ❑ C <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ l <br /> N <br /> STRUCTURE/ADDITION USE: --,.5'TCt) 1!t C' ° <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) ( ^ <br /> BUILDING CONTRACTOR: m �J <br /> m <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR _3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T "' <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) OT a <br /> -n 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(NS)AND INDICATE <br /> CNORTH o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m <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 ) <br /> MUST BE SIGNED AND DATED BY THE OWNER. o 0 <br /> O :3 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> f <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> 0 <br /> CONDITIONS OF PERMIT: <br /> 1 <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. rvj <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. <br /> ca > 0 > 0 <br /> 6. m x3 nm xn` ° <br /> .Q N a y N O 7 <br /> 7. O N N T`G 3 0 I-O <br /> �, m <br /> 1 declare that this application (including an accompanyingschedule has been examined by me and to the best of m A <br /> pp 1 9 Y ) y � � 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 J: m c mm <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- (� <br /> Vl � : <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 o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person t ave access to the above ribed premises at any reasonable time for the purpose of inspection. T a <br /> ID D <br /> SIGN HERE <br /> (signature ofyo�wn!jc"building contractor) (date) 0 <br /> ZONING ADMINISTRATOR V I(' �--3o,401'1 <br /> - EA ffl to <br /> O N (P W W N O <br /> OUIOGI OINO <br /> TOWNSHIP IPERMITS MAY BE REQUIRED a <br /> THJ P��I+ "� �e� P—K1 ONE <br /> mC21�PdRO A EIm ArYbU/ <br />