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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> OWNER W\C'M h4W Cana 3akt42// "Al TELEPHONE-1 'tpJle IS o <br /> Q �Ldf4 owl SN83b m <br /> MAILING ADDRESS,Q0 <br /> UOX i v r £O <br /> PROPERTY ADDRESS 5011.tf. <br /> y�u`1 <br /> LEGAL DESCRIPTION(see tax receipt) poA-%aLk6W LQ} V no No U4$4 rn <br /> m <br /> (NE W1V <br /> DWELLING/BUILDING & GARAGEIACCESSORY STRUCTURE ❑ ADDITION ❑ N 0 <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> 0 4 <br /> STRUCTURE/ADDITION USE: Ilium?- <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) W (� <br /> m � <br /> BUILDING CONTRACTOR: m (n <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 6%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 C <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n � k4l <br /> M <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) OnQ _ <br /> T <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m �? <br /> NORTH(N). C �- o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S)TO m 17 3 <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 4..� Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ` rt� P <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO �+I <br /> BUILDINGS,ROADS, LAKE, LOT LINES. 1 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Q N <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 w <br /> o � I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o 01 <br /> NEEDED. (� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <br /> I rtv� I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. „I <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 /> X 1DOr DO DO L <br /> m cym 0 m o :E m <br /> 6. m s3 nm Fam <br /> om C0. '� o = 3 <br /> 7. Z y y ' = O <br /> 0 <br /> 1 declare that this application (including an accompanyingschedule has been examined b me and to the best of m <br /> PP ( 9 Y ) Y y <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize (� m c I m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> 7 : 0 : <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 ,o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. ' m ' z <br /> T a : <br /> m n <br /> q ^ t m n <br /> SIGN HERE �'-- 1- V_I'0V' <br /> I nature <br /> of owner or buil�ng contractor) (date) 0 <br /> ZONING ADMINISTRATOR itr1 1 <br /> w »sv <br /> TOWNSHIP PERMITS MAY BE REQUIRED O u u <br /> T S PERMIT SHALL EXPIRE QNE Y AR FROM DATE OF ISSUANCE <br /> V-m�k4 ►ef-I-rQlckujo bg <br /> --r-r <br />