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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator -D G) Z <br /> CD 0 <br /> APPLICATION FOR LAND USE PERMITS . <br /> r <br /> OWNER W t L-L t Or M cY 7/kt2r3 IV(Ia l't L131=nFLEPHONE v <br /> 9 r� ]'\ m <br /> MAILINGADDRESS t�/ �j� r}/l)(� jE�t� �� Jy(I��j (��� 0 <br /> �g "1 ° m <br /> PROPERTY ADDRESS <br /> 1/ Q y <br /> LEGAL DESCRIPTION(see tax receipt) N W AW Lot C5t)i V Ia .P/S <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION <br /> TYPE OF PERMIT(S): c� <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION a <br /> STRUCTURE/ADDITION USE: C-51 Of-,t,t5 JC/3i11 t L 9 j.{p M t 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) y C <br /> LL m <br /> BUILDING CONTRACTOR: d t(Y <br /> � � 1 <br /> m <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. m <br /> M m ` <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p CDnZ <br /> oma' <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n r ` <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 1 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. 1 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. ' N <br /> S. 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 0 Uj <br /> MUST BE SIGNED AND DATED BY THE OWNER. o91 <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFIC T�_ Oo r <br /> NEEDED, J J/ n�I�NE WHEN <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. `1 V oZ Q <br /> CONDITIONS OF PERMIT: <br /> MAY <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PbVI. �3 / <br /> ISSUANCE. Q(J <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE f, Qv l� <br /> 3 NO GRADING <br /> OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 2Q/�,Q IV <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER O <br /> SETBACK AREA. � `� � �/ <br /> 5. s r5 tD Ukf, 6-e � �U � �d m Cir a li t�i E�f?�, <br /> 6. ! Wt _,j <br /> t ,j t7� � � r S F XLeP 7 t- (5k CD <br /> m c 00 0 o m <br /> V N N <br /> 7. Ngo : <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c N O <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d C : in 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- m 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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection m <br /> o : <br /> SIGN HERE <br /> a <br /> (sl atu a of owner or I ng contractor) date) <br /> ZONING ADMINISTRATOR <br /> fA fA EA di�N <br /> N N N O O <br /> N 0 fT (TOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> a63� <br />