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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator T o 0 <br /> APPLICATION FOR LAND USE PERMITS . <br /> N <br /> �" a <br /> OWNER (Ckw�s,1 n� t1-,4 1 N ii TELEPHONE ?6 <br /> h� �+ f a)" <br /> O, <br /> MAILING ADDRESS /8 a� /tS�eN N h AAT ID_ 6 Al d 5L),ii <br /> //-- ' <br /> PROPERTYADDRESS � ,�✓� �� �F- 1)AnJ , A4 W <br /> LEGAL DESCRIPTION(see tax receipt) <br /> /�1 1�j�s �eY �v T q i-ZoT' 1 <br /> rr fr �I <br /> DWELLING/BUILDING LJ IaARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ (((��C\ o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT 1:1SUBDIVISION ❑ 1 <br /> STRUCTURE/ADDITION USE: r ✓A el to L ° <br /> _ <br /> (Home/Cabin; Commercial Business;Bedroom; Deck;etc.) d <br /> /v c5 nJ v C r <br /> BUILDING CONTRACTOR: � <br /> S Y ew Gi W l ` 7 �, <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET APER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> M <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> � o 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(NB)AND INDICATE <br /> NORTH(N). co o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m a <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. o d` <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR IF w <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CON' 11 <br /> E PLANS ) ° <br /> MUST BE SIGNED AND DATED BY THE OWNER. Al I ' ' <br /> �ll _ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICAT/WN MAY BE DO H ° <br /> NEEDED. (((((JJJJJA 4# ° <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS o <br /> 1 DRIVEWAY <br /> MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 20N�N�viy <br /> SS7), �p <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. (+/ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY O r v <br /> PERMITTED. W <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK <br /> ,LAREA. <br /> 5. -� / <br /> ip <br /> m on d o °D f m <br /> 6. 3 CL m am M <br /> O N C y N 0 3 <br /> 7. <br /> O <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of n 0 A <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m O <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- f' CD <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. o : <br /> SIGN HERE ,�c —Aq Q a <br /> (signature of igKor Wnn%r., (date) <br /> b <br /> ZONING ADMINISTRATOR -/©—®�� Q (A 6� <br /> ON N OO <br /> T WNSHIP PERMITS MAY BE REQUIREDv Q <br /> G lktW 17 J <br />