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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator v ci Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> rn o <br /> Ul <br /> OWNER [C,rl-adv ,_leC7i-, TELEPHONE n <br /> � <br /> d <br /> / L / m <br /> MAILINGADDRESS LlSb � Ile '114V�e13dre 1, y lbml O <br /> PROPERTY ADDRESS L! t�- I- / / [l r`! / <br /> LEGAL DESCRIPTION(see tax receipt) z y — 3_3 -o2 )oo C <br /> DWELLING/BUILDING ❑ GARAGE/ CCESSORY STRUCTURE ADDITION ❑ qj <br /> q 0 <br /> TYPE OF PERMIT(S): Q ' <br /> FILLING/GRADLNG ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> / a <br /> STRUCTURE/ADDITIONUSE: leC�� ,k� �(' 6SA A, b>.-- 0 <br /> (Home/Cabin; Commercial Business;Bedroom;Deck;etc.) Cn <br /> ti GG (� <br /> BUILDING CONTRACTOR: C✓_�d 4C /`-z'cCC'- <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> kw <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T 3 <br /> H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> m a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n ju <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m L 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. 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. o n. � <br /> o W <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a o <br /> NEEDED. M <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> 10 <br /> CONDITIONS OF PERMIT: n <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT �J I <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. <br /> 5. JQ <br /> m W 0Ma £ m <br /> 6. v m C o F o 3 <br /> N tl <br /> 7. <br /> o T G M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C <br /> w: <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of n 0 N <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize (D 0 : m <br /> that this information I am providing will be relied upon by the County of Bur if17 <br /> rung whether to is- `� <br /> sue a permit. I further accept all liability which may be a result of the t <br /> P P b Y ao+l►�ly or ttl r o�tMis information I am m <br /> providing in this application. I agree to permit county officials charg�d Fkihity( dinances or other <br /> gid <br /> authorized person to a ac s to thev ascribed premises of hny reasonable time for the pu os; of inspection. m fD <br /> of <br /> CD m : <br /> SIGN HERE L NOV 2 6 2002` y-oz <br /> CL : <br /> (s na�turree of owner or building contractor) ate) <br /> ZONING ADMINISTRATOR Jim ,1ta�l <br /> J BURNETT COUNTY <br /> ZONING <br /> ' EA di fA fA�N <br /> N UiNN00 <br /> (P O U tr O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />