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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator ' o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> VT O <br /> y <br /> OWMER � �i1/��UC't ` A4 7 TELEPHONE Yl j-6' - 7 Y / 3 v <br /> 777���777�� m <br /> MAILING ADDRESS y s y K is 2 r�PQo pj C- )2 (,U! sAl 000l v <br /> r <br /> o_ <br /> PROPERTY ADDRESS S A M A <br /> /,OTS 9 of CaV7- 46 ff' I <br /> LEGAL DESCRIPTION(see tax receipt) S�r C �Q S CO T T Tw.S PCn <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ o'Z <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRRADIN'G ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITIONUSE: 1.OV/elz D t�OOlz Lywe y, L yct– !� <br /> (Home/Cabin; Commercial Business;Bedroom; Deck;etc.) to <br /> m <br /> BUILDING CONTRACTOR: C GUN k& w <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 61/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 9 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> IZI N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> TZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 3 m X <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 9 <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m B <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. LJ <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 <br /> v <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 O <br /> CONDITIONS OF PERMIT: <br /> 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT V <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 /> LfyCKAREA. <br /> 5 OTS/i-c4J2 _- <br /> m W 0 0 MCD <br /> M <br /> Z N m o <br /> 7. o -n � <br /> M <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my �j A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m n <« <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize (D 0 m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- (� <br /> m : <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 d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized pers n to have access to the above described premises at any reasonable time for the purpose of inspection. (D Cn <br /> m o : <br /> N N <br /> SIGN HERE <br /> n <br /> d4 (s)gdXur <br /> nato ner r building contractor) date) <br /> ZONING ADMINISTRATOR 7 ' <br /> fA 0 EA EA 0 N <br /> N N N N O O <br /> Ut OfT (TOO <br /> TOWNS IP PERMITS MAY BE REQUIRED <br />