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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -U ci Z <br /> APPLICATION FOR LAND USE PERMITS 3 ° <br /> r <br /> y O <br /> 6 D . a l l H 7/715'--48 <br /> OWNER CD <br /> C e rf v TELEPHONE B 7/5 - 'l$�i —3Z41 o <br /> m <br /> MAILING ADDRESS 141 g 5 Sv nrshiWe S+r, S f- C POIX -F1)5, W:L 54D a V � o <br /> PROPERTY ADDRESS SP-NICVi&W �F�t� �o f �f e� 500)iSe- ` <br /> I _•1 <br /> LEGAL DESCRIPTION(see tax receipt) o <br /> + 11 sNN,~s� 02 pglly -'6" N�- <br /> DWELLING/BUILDING © GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ <br /> TYPE OF PERMIT(S): 1 rn 5 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITIONUSE: <br /> (Home/Cabin, Commercial Business; Bedroom; Deck;etc.) <br /> rW ° <br /> BUILDING CONTRACTOR: oGt;r+ D.7 o <br /> d <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n n. <br /> DIRECTIONS FOR PLOT PLAN DRAWING• (AERIAL OR TOP VIEW) <br /> O m <br /> T o- <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m v <br /> NORTH(N). <br /> m <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. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO o <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <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 <br /> f <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: o p( <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. 4' <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY G <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA <br /> ( /� G,Z <br /> or► anf - <br /> I J 3D oo � <br /> �GC�LCA `��< q -a' c a <br /> CD <br /> oCD <br /> '0 3 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my // �� A <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that 1 am responsible for the detail and accuracy of �J4 m <n e <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize m o m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- fD <br /> providing in this application. I agree to permit county officials charged with administering county ordinances <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 /> or other w <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. CO <br /> Zr <br /> o . <br /> SIGN HERE <br /> (signature of owner or building co tor) r, c(date) . . <br /> ZONING ADMINISTRATOR <br /> nCAR V N di Vf fA N <br /> N U i N N 0 0 <br /> TO NSHIP PERMITS MAY B REQ IREDn51 cn o 0 <br />