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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 /> y O <br /> y <br /> C <br /> N <br /> i a <br /> OWNER M arSh a TELEPHONE to-5( '3 5 Q o <br /> O <br /> MAILING ADDRESS y�Spa d^� }�Ve r( ar-N (Ll(`/ i 5CD <br /> ��^' r <br /> 0 <br /> PROPERTYADDRESS Is OL . <br /> Lot 10 <br /> LEGAL DESCRIPTION(see tax receipt) Tw , Rito AM, .Br&,,,Ks : ,b t r 1 M <br /> DWELLING/BUILDING 0 GARAGE/ACCESSORY STRUCTURE u ADDITION ❑ �j U <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT 1:1SUBDIVISION ❑ �. <br /> STRUCTURE/ADDITION USE: Q3 -f q-%Q Q-- Si <br /> 0 f Q^ e 9 a i j)mQ-h� �U � y 0 � <br /> C (� (Home/Cabin; Commercial sines ;Bedroom; Deck;etc.) W <br /> BUILDING CONTRACTOR: S T <br /> m ^ <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR _n 3 �7 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> -A N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n o <br /> -n <br /> F1p 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 m <br /> NORTH(N). 0 o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 9 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. ji <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. rv� <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. f l <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <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. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. 9Ve7-'� �E (,(SDi > <br /> oD FbPL PU,6 ' � 0�2 �M ME12r�a� CASE <br /> CD o0c <br /> W �r 0. V <br /> n 3 nm xam � <br /> m <br /> 6. � � c N <br /> z m 0 <br /> 7. m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �j=r : ID <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy ofJ n a <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize S 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- <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or otherN <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. o <br /> CD <br /> (� (� m <br /> SIGN HERE <br /> a : <br /> (signature of owner or building contractor) (date) (f'� <br /> ZONING ADMINISTRATOR I <br /> e»to <br /> EA fA fA EA -+ N <br /> N (l N N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />