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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> 5T o <br /> Ch <br /> c <br /> � Q <br /> OWNER SQ-3 +Jp a o �J 6 h n S 6 r) TELEPHONE n' .- <br /> v <br /> MAILING ADDRESS <br /> S460 /- <br /> r- <br /> 0 <br /> PROPERTY ADDRESS � <br /> L�u,►� I?o( <br /> A <br /> LEGAL DESCRIPTION(see tax receipt) C> CD <br /> CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ( o <br /> 1� <br /> TYPE OF PERMIT(S): C =3 <br /> Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION El <br /> a <br /> STRUCTURE/ADDITION USE: p `� <br /> o' <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) CD <br /> W `" 1 <br /> BUILDING CONTRACTOR: <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. -n 3 <br /> O — <br /> ;a c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n ov <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE MCD <br /> NORTH(N). C , <br /> CA <br /> 1 , <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 MARKOHWM OF , <br /> ( ) <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. N <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. <br /> �,coo <br /> 0 <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 LJ <br /> CONDITIONS OF PERMIT: 9 <br /> 1 � <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 RESTRICT <br /> ED ALONG SHORELINE. <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 /> 0 > > n n a <br /> 7. c <br /> o CD <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of m <br /> knowledge and belief it is true, correct and complete. I y c ~ <br /> p acknowledge that I am responsible for the detail and accuracy,of o. 0 <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize cv <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- CD <br /> cn <br /> sue a permit. <br /> p I further accept all liability which may be a result of the County of Burnett relying on this information I am v o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other co C <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> D-z n <br /> m � <br />