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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -u o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. w <br /> — r <br /> UT O <br /> OWNER A N DREV/VI V. 'SM 1' I _\ TELEPHONE �``3 — Z�03 — CO 9 1 G7 <br /> MAILING ADDRESS Z 4-I D c-, l .—d��,'p-7S ��C�7 �v L , K t\1 55 309 <br /> PROPERTY ADDRESS E"I m G SU K11 L1�T V dYAC�r3Z U I LLALiE. w��STE� . wZ <br /> �4�q 3 1, <br /> LEGAL DESCRIPTION(see tax receipt) LUF 40 &1k,nGin � �M <br /> DWELLING/BUILDING ® GARAGE/ACCESSO STRUCTURE ADDITION ❑ 0 <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: o <br /> 0 <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Cn <br /> BUILDING CONTRACTOR: <br /> m <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. m ^ <br /> O <br /> -A m C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). 0 <br /> I <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO CA ` 0 v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 1 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Z Z <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO 111 <br /> BUILDINGS,ROADS, LAKE, LOT LINES. R C <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. �! <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS I� <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN � 0 J <br /> NEEDED. <br /> U^ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o r J l <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 J <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER Oe <br /> SETBACK AREA. V <br /> 5. <br /> m W= 0CDaf m <br /> 6. 0 0 a <br /> �O � amfD >J <br /> 'O N : y y 0 �' 3 <br /> 7. <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of rn �j 2C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of w F» <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m ao G <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> C): <br /> sue a permit. I further accept all liability which may be a result of the County of n I ann00 <br /> providing in this application. I-agree to permit county officials charged with i ri Pl other <br /> authorized person to hav access to the above described premi es at any reas i r e ion. - . o <br /> 1m m <br /> SIGN HERE JU, ' L� n� a <br /> (signatuurr of owns r building contractor) `i `rL4 e) j <br /> ZONING ADMINISTRATOR J <br /> I IhITV � <br /> fA fA fA rl N <br /> ZONING N N N O <br /> N O U Vt O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />