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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 G) Z <br /> APPLICATION FOR LAND USE PERMITS _3. <br /> r <br /> 41 <br /> OWNER �d L, —� 5114 r& TELEPHONE <br /> Wit! o (� ' <br /> MAILING ADDRESS �OtS (Wr►1ffft-yee+ j LCD <br /> �o005�r m <br /> PROPERTYADDRESS 1 <br /> LEGAL DESCRIPTION(see tax receipt) 1 <br /> -- <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION w o` M <br /> TYPE OF PERMIT(S): C TT{-� <br /> Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ S: <br /> STRUCTURE/ADDITION USE: 5e L 3a <br /> (Home/Cabin; Commercial Business; BedrIbom, Deck; etc.) Cn V —1 <br /> BUILDING CONTRACTOR: �� �Qp(y�yr� ( 8�3 = (� <br /> t C/) <br /> v <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. see /�1,&� O � <br /> (� 0 CD O <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) <br /> n a <br /> T _ <br /> TZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n o A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). C <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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. f fl Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO V`t o <br /> BUILDINGS, ROADS, LAKE,LOT LINES. P * . <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. <br /> f r <br /> q ^C <br /> NOTE: BUILDING/STRUCTURE 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 <br /> ISSUANCE. r <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ` z <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. <br /> 6. (CD c° m W o MOaOv <br /> F m <br /> m x 3 a (0v 0, n <br /> 7. o N c y a 3 <br /> Z C iA O <br /> (ND T`< m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my O <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 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 m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> (n 17 <br /> O : <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am = : <br /> : M o <br /> providing in this appli tion. I a e to permit county officials charged with administering county ordinances or other m' <br /> authorized person t e acc the above described premises at any reasonable time for the purpose of inspection. m <br /> CD a <br /> c�lD D <br /> SIGN HERE n <br /> (s' n ure of owne�oor building contractor) (date) o <br /> ZONING ADMINISTRATOR t1/� <br /> �EA b9 Eflf <br /> O N V W <br /> TOWNSHIP PERMITS MAY BE REQUIRED o cn o c <br /> THIS PERMIT SHALL XP RE ONE YEAR F O DA OF SSU NSE <br /> �rm1+ 4 !e.-� mail he1Ps ��%�aCe�s 8-a-a5 <br />