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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> to O <br /> N <br /> C <br /> N <br /> OWNER nn&1 f1-�rlly <br /> TELEPHONE <br /> �,y V� O <br /> MAILING ADDRESS ' /�,�"` '�VaI r <br /> PROPERTYADDRESS d <br /> LEGAL DESCRIPTION(see tax receipt) aC —q Iµ-i5-G oj% l � �10 W h v T 66 t m <br /> ^ <br /> n <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITIONX <br /> TYPE OF PERMIT(S): n 4- <br /> FILLING/((G'RADING El CAMPING UNIT ❑ SUBDIVISION El <br /> STRUCTURE/ADDITION USE: - G rn t l v M / f- <br /> -� (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) iv Vl <br /> BUILDING CONTRACTOR: Sd' -F <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <� <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p = <br /> W N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m J <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C m T n <br /> NORTH(N). fn ° <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 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. ° <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. o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. F t <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q ° <br /> NEEDED. co <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o d Q <br /> CONDITIONS OF PERMIT: tom, <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT W <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. C111) <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY W <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> CD cW m 0 C a m <br /> 6. m x3 <br /> 7. p wCb T`o <br /> = V1 : m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m A <br /> PP (� 9 Y ) Y Y G7� � : C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of w ° <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize m <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 r? ° <br /> providing in this plication. I agree to permit county officials charged with r her o m <br /> authorized per n o have ss to a above described premises at any reas ort r n. ° a <br /> T <br /> N a <br /> N <br /> SIGN HERE 169 ° <br /> s nature of owner o buildin co ( ` ° <br /> 9 ntractor' AUG 8X165 <br /> ZONING ADMINISTRATOR <br /> BURNETT COUNTY o N W w N o <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING <br /> THIS PERMIT SHALL,EXPI E O E YEAR FROM�A OF ISSUANCE�C Q � L/„ <br />