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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 /> 5 o <br /> r <br /> /1 i,, a <br /> OMER Ctyc,' �yrr WQi/sem TELEPHONE <S- 6 3E <br /> MAILING ADDRESS <, .IJ e4. L( / 5-040,lS! <br /> PROPERTY ADDRESS in C?./ <br /> - 9 R.i'� <br /> f . <br /> LEGAL DESCRIPTION(see tax receipt) L_qe til CKe/lZ i C BeQC-/Y Sub. F_ a 5 LOt G, tot <br /> DWELLING/BUILDING GARAGE/ACCESSORYSTRUCTURE ❑ ADDITION ❑ �k 5 rnr,:%o <br /> TYPE OF PERMIT(S): `ov <br /> FILLING//GRADIING ❑ CAMPING UNIT ❑ SUBDIVISION <br /> ❑ S.— <br /> STRUCTURE/ADDITION USE: <br /> STRUCTURE/ADDITIONUSE: /Ox o 0U} <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR:1128-P® `Q.G <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p (� <br /> A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 0 <br /> -n 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). y ` 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m .4,� � <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. 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. Q <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 09 <br /> MUST BE SIGNED AND DATED BY THE OWNER. i'o <br /> v � � <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o C <br /> CONDITIONS OF PERMIT: C► <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. UJ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Q <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY O <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. s ee o-F qo' -tz) near I's not k e.lj? role-t, /i <br /> .1 q� m W w, omn * m <br /> 6. 1^1 ��a-hI� afprrly / IVI�It� C &ua- Y Le 4OUJ-AU/ 3 a ' y n fD 3 <br /> �b'tCA UVt,Cl� r7C► �� 57> °�o C, F tie c( UAf rlG�2P1 C N <br /> 7. Z w m o : 6 � 1 <br /> o T� M <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my its, G) c ID <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o » <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- G) <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 person to have access to the above described premises at any reasonable time for the purpose of inspection. CD <br /> o <br /> CD <br /> (D m <br /> SIGN HERE <br /> (signature ner or building cont or) (date) <br /> ZONING ADMINISTRATOR ^ <br /> fA <br /> (A(A(A df-N <br /> ry N N N N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />