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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 /> r <br /> N <br /> N <br /> OWNER /1I ,n + � TELEPHONEG7i4S- <br /> MAILING ADDRESS (Xjaj,% 9.Q l� �siPJ7� <br /> PROPERTY ADDRESS L 9 S C .t,e_,r 1-C¢,f,Lt- 0 <br /> LEGAL DESCRIPTION(see tax receipt) L Q' T 9 Si.4nt .2 Qr.�eQ -3 g 0 <br /> OWELLINGIBUILDING y[]I GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ U) o <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: L N 0 <br /> HomRe/CIKommercial Business; Bedroom; Deck; etc.) <br /> ApR Y AL BESBUILDING CONTRACTOR: <br /> m <br /> -a c <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. Qu � 'J_�-O,S QC- A c / n <br /> DIRECTIONS FOR PLOT PLAN DRAWING' (AERIAL OR TOP VIEW) 8 D O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m '� <br /> NORTH(N). ca <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m CT B <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF n ' <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. N P <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. ly <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS t <br /> MUST BE SIGNED AND DATED BY THE OWNER. E <br /> o � <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <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 J ;ZSISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY O9 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. No <br /> MC m M 0 0 n f m <br /> 6. N F 3 a M F a N K <br /> omcN `.' og3 <br /> 7. <br /> Z cinmo <br /> .'O <br /> w . m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my MI� L7 C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize mo <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> [ O : 0 <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 m o <br /> providing in this application. I agree to permit county officials charged with acim491 er <br /> authorized person t av access to the above described premises at any reaso r r i <br /> m <br /> SIGN HERE <br /> (sig a of owner o building contractor) OCT ^ �dp�� <br /> ZONING ADMINISTRATOR ( // <br /> BURNETTCOUNTY ^"�N <br /> O N N W W N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING Q o u o n n v o <br /> THIS PE4R-�MIIT SHALL EXPIRE`ONE/YEAR FROM ATE O ISSIUUAN�CE V <br />