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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 /> - o <br /> N <br /> C <br /> N <br /> OWNER C�05-60xr Na Ft, TELEPHONE o Q. <br /> MAILINGADDRESS 14k,4I5 8ti't'` N O <br /> =r � <br /> n D � 0 <br /> PROPERTYADDRESS R <br /> l_b�7�t� -L L <br /> LEGAL DESCRIPTION(see tax receipt) a cn <br /> _ 1--+7! <br /> DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ o <br /> c 7 <br /> TYPE OF PERMIT(S): � Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> N <br /> STRUCTURE/ADDITION USE: ©W�-�_ 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) 091 <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN BY:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. Z T <br /> O�S� -le. LILI °� � o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). _ <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S)TO m -3a <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. it <br /> o <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 CI 0 N <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN 0 •/- <br /> NEEDED. N <br /> r <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z 00 <br /> 0 <br /> CONDITIONS OF PERMIT: f„ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT O <br /> ISSUANCE. 1� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ( O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY \;lY�1? <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> M a) > 0 a 0 't7 <br /> fm <br /> 6. m s 3 n m 0 S M A <br /> a p m C y N o 5 3 <br /> 7. Z <br /> O <br /> = m m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ; cj 2 A <br /> c C <br /> knowledge and belief it is true, correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of m a <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m c 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 m o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other [ m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> r n : <br /> SIGN HERE /2�" 41 O(e a <br /> e3 n <br /> (signatu'reo�owner orl b/u�ild�ingyontmraclor) (date) 0 i <br /> ZONING ADMINISTRATOR V�1 <br /> �fA fA fA fA�N <br /> O N O N N P O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FR qM DA E OF I $UANC <br /> mczl 7- ,(�vr lcndf ui SKS -a0-06 <br />