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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator -1 o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N � <br /> �J_l 1 I Gf r�n � <br /> OWNER Q `!ry ���I e � J I-TLEPHONE ij� 3 O&tS^ <br /> MAILING ADDRESS a I e ST �(i P V �y"'J7 / /(ISN 5534, OQ <br /> PROPERTYADDRESS ygs� I��t'LQh�� Act , � O <br /> LEGAL DESCRIPTION(see tax receipt) W�S �! .M (/" 1 <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ ,�,� <br /> TYPE OF PERMIT(S): <br /> v <br /> FILLING/GDING ❑ CAMPING SUBDIVISION ❑ a <br /> (� * p� N <br /> STRUCTURE/ADDITIONOSE: ~ 00 V' N UN /d-h "(j'� � P6�() o <br /> ,p (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: ` C P d <br /> m <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. 3 <br /> /0 UT <br /> rb CW <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n �^ <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n 9t A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> n <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 1 <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. �fl 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. ^ <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 0. <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> o <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: c <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT \ i <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. }A <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER 1 <br /> SETBACK AREA. <br /> 5. ! /� /1 /� <br /> V(— / ,5/ ' A �/� �_L��� m Or,- > 0 > 0 -0 <br /> 6. <br /> 3 a 00 x a m <br /> -4 N C y fn O 3 <br /> 7. Z N W O m i <br /> O T� m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m 0d, <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m : o o <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ' <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 hav4l access to th above described premises at any reasonable time for the purpose of inspection. m c <br /> o : <br /> SIGN HERE ') d' <br /> a : <br /> iture of own or building contractor) (date) <br /> ZONING ADMINISTRATOR' <br /> (A di(A(A N <br /> N (T N N O O <br /> O U N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />