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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r- <br /> y O <br /> OWNER C-i'�?41YL� O �I/ TELEPHONE//�1� 11S—O(O <br /> MAILING ADDRESS �O, // j /4�i �3iL/� <br /> � T ( 0 m <br /> PROPERTY ADDRESSJJ <br /> d <br /> LEGAL DESCRIPTION(see tax receipt) �(, CC,C Cl S�L� („ Cn ` <br /> fpIJI <br /> DWELLING/BUILDING JqJ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION 11 (1Q-/b rn 0 <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ R;� <br /> STRUCTURE/ADDITION USE: ,r�?�h'!'!(t l� X 3b w/ l� X d P Or, n n� <br /> (Home/Cabin; Commercial Business;Bedroom; Deck;etc.) rn <br /> , <br /> BUILDING CONTRACTOR: <br /> Q <br /> mom' <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. <br /> 0 H G <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> In <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). W o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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. 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. Cs- <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. i NAli <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 0 () <br /> MUST BE SIGNED AND DATED BY THE OWNER. o E I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERTA v \� <br /> NEEDED. h <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. I, { o C� <br /> CONDITIONS OF PERMIT: J �VN J U n 1 [' ) <br /> Q <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELIN N NG UN1Y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Q <br /> PERMITTED. (�! <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. 6IL— C.l'(� t (/ <br /> Q m 3 0rOM�nf m <br /> 6. � B am � `;+m . <br /> o mcy !" o � 3 <br /> 7. Z y M o <br /> o Tom : <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ^/ a a aLJ <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 CL ID o : m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> G): <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. fD o <br /> m m � <br /> SIGN HERE ' ) d' n <br /> j(sIg of owner or builtli contractor) p/ (date) <br /> ZONING ADMINISTRATOR <br /> `J 1.9 <br /> C469n69 <br /> 69 <br /> _00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED /uc C `' <br /> S 2l�ti C� <br />