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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator CD- o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> y 0 <br /> y <br /> C <br /> y� nl <br /> ? <br /> OWNER TTELEPHONE }� pjjf( �a W <br /> �. � n <br /> m V <br /> MAILINGADDRESS 2 7 G /A,/ <br /> 0 <br /> PROPERTYADDRESS � i. oiJ/C /11 ', , -. A, <br /> LEGAL DESCRIPTION(see tax receipt) S C T,5 4 6, ♦ 1 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURED ADDITION ❑ Cn O <br /> C <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin,Commercial Business; Bedroom; Deck,etc.) <br /> BUILDING CONTRACTOR: '} <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 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O ^ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a �\ <br /> -n w Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m v <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> C o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <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. v ° <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, BUILDER, CONTRACTOR, ETC., THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. f <br /> o 041 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATi ) I WkI,EN o <br /> NEEDED. II�� �`G; " - e� <br /> � <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. n LL o <br /> CONDITIONS OF PERMIT: f7 <br /> MAy U <br /> 2002 I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIJ <br /> ISSUANCE.2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE.RNE�COU J-� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ZONING N <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK h/1ij� <br /> 5. a <br /> CD W � 0vavv <br /> d <br /> 6. U /� /� 3 am m <br /> B N C y y 0 <br /> Z v' ,p o <br /> 7. ° n m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of m 0 : in <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize m 0 : rno <br /> that this information 1 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 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. - ° o <br /> CD <br /> m <br /> SIGN HERE contract <br /> P �L <br /> signature of own o building contractor (date) t <br /> ZONING ADMINISTRATOR <br /> f»t» <br /> REN 69 fA fA N <br /> • p " �Ini Y 0 0 0 CN 0o 0o <br /> TOWNS IP PERMITS MAY BE REQUIRED <br /> q40's -&LTMy W" <br />