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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 ci Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> OWNERI1\ � 0 <br /> TELEPHONE/NT (/ D/ <br /> o <br /> MAILING ADDRESS� W( O <br /> �i�Z(S� W.T f <br /> � ^ <br /> PROPERTY ADDRESS 97?? 7 LimE AWE &.OA/J Wee 27-Y w2-- <br /> LEGAL DESCRIPTION(see tax receipt) LO CS" `' � <br /> CD <br /> DWELLING/BUILDING 1:1GARAGE/ACCESSORY STRUCTURE ADDITION 110 L4-N (1) o' <br /> TYPE OF PERMIT(S): �.OWNS� lJ c <br /> FILLING/GRADING ❑ CAMPING nUNIT ❑ SUBDIVISION El ( r a <br /> STRUCTURE/ADDITIONOSE: C /7-/�y'b:-?j2W lmmgm& 0 <br /> ,� <br /> (H/omee//Ca`bin; C�ommercial Business; Bedroom; Deck;etc.) Cn <br /> BUILDING CONTRACTOR: D Y� #NP4V'P t f S <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/z X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n 3 3 <br /> H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) M <br /> o h <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T-n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C <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 <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. 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. 2 <br /> --i Q <br /> o3 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN - o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z kV <br /> CONDITIONS OF PERMIT: P lIJ`�a <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. p i <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.6. Qj <br /> m3nmFa ;a <br /> O 0 C y y 0 ic <br /> 7' Z N O O 0 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my — q ID <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of d 0 v, C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m E o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 17 <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I amm <br /> providing in this ap lication. I agree to permit county officials charged with administering county ordinances or other kz,:* <br /> m <br /> authorized perso have access to the above described premises at any reasonable time for the purpose of inspection. s <br /> d T <br /> SIGN HERE L"0 11 .� M D3 .�l ASle3 <br /> F» iu <br /> (signature of own r br'Iding contractor) date o <br /> (date) <br /> ZONING ADMINISTRATOR ! J/ <br /> - Fn<n <br /> N(T N N O O <br /> (n0 (T fn 00 <br /> TOWNSHI PERMITS MAY BE REQUIRED <br />