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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator v G) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> OWNER tt X11 , 2�32 >8 /�''/ 0 I <br /> WC{ I rs TELEPHONE -7/5- J 4/7- 9-/S 5 lej n v <br /> m <br /> f/ <br /> MAILING ADDRESS SC� (� S� CTr /�PpIz U-4I1t� /y/S/ SNA�2/ O <br /> 0� m <br /> o <br /> PROPERTYADDRESS 66'17 7 W 1/t7tg Slreen CUA <br /> s4ef jo,n 213 Stt)Su' r B s+� ✓ a f <br /> LEGAL DESCRIPTION(see tax receipt) <br /> c�1�n 2 dw NW a e4 a 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING ❑ GARAGE CCESSORY STRUCTURE ADDITION ❑ c o' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: () )h <br /> 0 <br /> � <br /> j ,,y J (Home/Cabin, Commercial Business; Bedroom; Deck;etc.) m <br /> "" <br /> BUILDING CONTRACTOR: 1tl h <br /> - ,PS Vyl I rn l-t�l (7w� <br /> � <br /> m <br /> 1 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR N <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n 3 <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 m <br /> O c <br /> T o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. ? <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE n o A <br /> 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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF ° <br /> Z <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. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS wos- <br /> MUST W <br /> BE SIGNED AND DATED BY THE OWNER. o <br /> f I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN � o� <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. �( Z <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OFP IT <br /> ISSUANCE. _ 4. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHOR INE. <br /> 3 NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY INE. <br /> 4m <br /> NO SETBACK REA STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED ACOUA'� <br /> 5. <br /> O <br /> 6. m M oDvv <br /> M a <br /> 3 c. m 0, 9- A <br /> 7. mcN ' o � 3 <br /> Z N N O O 'a <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my - m A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofm C C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m - o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- t7 <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 � m <br /> authorized person to ve access to the above described premises at any reasonable time for the purpose of inspection. <br /> 0 <br /> c <br /> CD m : <br /> SIGN HERE <br /> Is na re of own building contractor) n <br /> may/ (date) <br /> ZONING ADMINISTRATOR <br /> � fn to <br /> N N N N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 <br />