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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator T 0 z <br /> APPLICATION FOR LAND USE PERMITS 3. . <br /> F o _ <br /> 4 ~ 4 F 7-�/� / C <br /> • <br /> OWNER 4 T C 4,4? E TELEPHONE e� —</S — 3,3 �.�/( CDQ <br /> 2 7 � v <br /> a) DO <br /> MAILING ADDRESS 16 FP <br /> r m <br /> o <br /> PROPERTY ADDRESS /� t <br /> A <br /> LEGAL DESCRIPTION(see tax receipt) cn <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ 0 <br /> 0 <br /> TYPE OF PERMIT(S): C <br /> Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: �t�- o' <br /> � D l <br /> (Home/Cabin; Commercial Business; Bedroom; Dec , etc.) CD <br /> 0 <br /> 2. <br /> BUILDING CONTRACTOR: <br /> Or> <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n CA) <br /> O <br /> hy PA , X Cn C>� <br /> DIRECTIONS FOR PLOT PLAN DRAWING. AERIAL OR TOP VIEW <br /> C <br /> a <br /> n z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n v ' <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). c o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m � <br /> CENTERLINE OF ROAD, C BUILDINGS MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <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 i <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, BUILDER,CONTRACTOR, ETC.,THE PLANS J 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 9) o <br /> NEEDED. <br /> XJ <br /> W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z d �J <br /> CONDITIONS OF PERMIT: o <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 � <br /> .SHORELINE s <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Q>0 C <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. , <br /> 5. L'CL�� 69+, 6Zd!f In uSl- �r► Imo..- d����� ��'96 <br /> 6. 7 <br /> w o � �Y�-r 1c, rn c W°'0 M a R <br /> CD 3 a <br /> a <br /> c� �.o <br /> c N N o Cn ? <br /> 7. z `Q <br /> I-- <br /> 0 Cn m <br /> rr <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best ofmy <br /> PP (� 9 Y ) Y Y "c -4 C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize cv R <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 v o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or otherCD <br /> authorized qefe4Ln to have access to the above described premises at any reasonable time for the purpose of inspection. m a <br /> m <br />