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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator -U c) Z <br /> APPLICATION FOR LAND USE PERMITS 3 o <br /> J�J <br /> UT 0 O <br /> N <br /> C <br /> /+ I Q <br /> OWNER l 7 .N d l/4 TELEPHONE <br /> �y 1JO '7- <br /> MAILING ADDRESS O <br /> oOU��s nnP Y` Lk. Rd, 1 QV buIrk yL �. aqa <br /> CD <br /> -Ij0 <br /> PROPERTY ADDRESS <br /> --)CAM p 1 <br /> Lots /0�l1 ,8 k r�I�� o� Cn <br /> LEGAL DESCRIPTION(see tax receipt) D h n Lake- h<.MIA C \ <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ <br /> o <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: GQV Gc1 P_ /.�1 r11/Vl 4 to <br /> J f�� me/ abin;Commer ' Business; Bedro-oom Deck,etc.) U) <br /> BUILDING CONTRACTOR: L�Lis I V� (,(l J {/ / {j�l C E,' <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. n 3 <br /> Zl N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p � O <br /> T o. <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> n d :b <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 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 � 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF V i 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 /> S. 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 <br /> F <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o o C� <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o I <br /> CONDITIONS OF PERMIT: <br /> / Q <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. ry <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER lJ <br /> SETBACK ARE /� / JJ``L— / <br /> 5.C)[tYQ� fD � /01 "1�7Y1 S/Cl e- I-b t- l)/)� b-et uiu r) LCr E r/ r <br /> urt0j � G� �/Yll� or,�Q 10 0 a E rn-0 3 a H 0 n A <br /> 7. Z u�� m o E5. <br /> 3 <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of d n : En <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize :' m 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 /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am uG, <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection m <br /> // - ' -n O <br /> J�cf �Da <br /> 3 C <br /> SIGN HERE �(�— d' � <br /> P <br /> (signatu owner or buildin P'�pp/�ti�ractor) date) <br /> ZONING ADMINISTRATOR 'IC(�!►� <br /> ' va to <br /> M(n fA QN 0 N <br /> N N N N O O <br /> Ut O fT Ut O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />