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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 /> F O <br /> OWNER 0__�Sk� TELEPHONE 7��� -� / _��g o <br /> MAILINGADDRESS S037 � �K 5 , / k) S.S�fC3 f <br /> r m <br /> 0 <br /> PROPERTYADDRESS LST✓W� � <br /> LEGAL DESCRIPTION(see tax receipt) L <br /> at / L/&& <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE M ADDITION ❑ U) ° <br /> TYPE OF PERMIT(S): �M/ a <br /> FILLING/GRADING CAMPING UNIT IrCI� SUBDIVISION ❑ `1 -per <br /> STRUCTURE/ADDITION USE: ( t�r v_� /✓) /I�/ /l L l J�the — �U �y0 ��� (� f <br /> (Home abin; Commercial Business;Bedroom;Deck;etc.) m <br /> BUILDING CONTRACTOR: <br /> T - <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 I <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> MN <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n <br /> r oz <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m 30 <br /> 2 .SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m \ <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <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. 41 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS _ C <br /> o <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> C � d <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. C� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ` n <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Ir 0 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER �\ <br /> SETBACK AREA. �+.1 <br /> 5. <br /> m 0r- > vnvv <br /> 6. <br /> 3 nm Fns A <br /> W C a m O 3 <br /> 7. Z Hm0 0i01 <br /> -n m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my L7 c C <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of u n in: <br /> CL n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize �G: m 0 : my <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- U, <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 have access to the above described premises at any reasonable time for the purpose of inspection. `D o <br /> CD <br /> t O m <br /> SIGN HERE J 7 <br /> a <br /> L <br /> c : <br /> (signature of owner w Ing contractor) % (date) <br /> t <br /> ZONING ADMINISTRATOR <br /> MEN EA fA � N <br /> N N N N O O <br /> (TO (T (TOO <br /> TOWNSH PERMITS MAY BE REQUIRED y109 <br />