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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> 1- 4,kE 7E,,r 3 <br /> j� //// p CD <br /> OWNER �/ TELEP E �E <br /> MAILINGADDRESS Z 5 Z ( <br /> PROPERTY ADDRESSCn <br /> 1 <br /> �� I — <br /> LEGAL DESCRIPTION(see tax receipt)t a Q d PC] <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ cn O <br /> TYPE OF PERMIT(S): � Q � <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SU VISION ❑ <br /> / H <br /> STRUCTURE/ADDITION USE: U V UN Id <br /> (Home Cabin;Comm rcial Business;Bed ro Dec ; c.) m <br /> BUILDING CONTRACTOR: cfhJ � <br /> lgcAr6g - Phl 71S <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> z Mc <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) o (� <br /> ?r Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m� 0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE \ <br /> NORTH(N). y 3S <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m Q <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z O✓ <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 9 <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, BUILD CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. t # <br /> U ftiFl;. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE V R N WHEN <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. do` <br /> ` o W <br /> CONDITIONS OF PERMIT: eU / POP I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PE <br /> ISSUANCE. pL4 C,OifN l <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHOR <br /> G <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 ^Q <br /> SETBACCCK!!AREA. <br /> 5. �eN /��1� C7'^ (�/J (JIC (L�"/ m m w 0 M CLO 'a <br /> M <br /> 7. y „ o : , � <br /> o T�2 2a <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G)c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m o v+ <br /> 0. : o, : <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m O . mt7 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- i CD� <br /> sue a permit. 1 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 applica ' I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to h access to the above cl#scribed prelni§yA.at any reasonable time for the purpose of inspection. m ° o <br /> w y m <br /> SIGN HERE <br /> (signature <br /> ^of own or Iding contrac or) (date) n <br /> V Y <br /> ZONING ADMINISTRAT N <br /> 13181- aao�-s LA0 O <br /> NCTN NOO <br /> U10 (l1 Ui00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> oAa3(o33- "-v <br />