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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N O <br /> m <br /> C <br /> W <br /> OWNER�6�p,S CA)..DfJ7w� TELEPHONE (pSl-��3-351QS o <br /> v� <br /> m <br /> 00 <br /> MAILING ADDRESS T <br /> PROPERTYADDRESS 3 o J 33 mi^-&,-o&- fOP►.ti 2�l11 <br /> LEGAL DESCRIPTION(see tax receipt) y I45 I J�B�f ,f / t 35j l.u-�a3 1?A - fib• C U I CD <br /> (� <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ° <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION <br /> ❑ <br /> ` ' ) 0STRUCTURE/ADDITIONOSE: <br /> (Home/Cabin; CommercialBusiness;Be oom; Deck;etc.) 0 <br /> BUILDING CONTRACTOR: '2t ej m <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/z X 11 SHEET OF PAPER. ANY INCOMPLETE R 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. Q�si 0 m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) je OaYy(1iL /�p1 0 M <br /> T CL <br /> -n ^� �m Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m 1 X <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> C o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m D <br /> v <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. o <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO Q <br /> BUILDINGS, ROADS, LAKE, LOT LINES. fL> <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I 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 /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° <br /> NEEDED. ' <br /> P <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o W <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT (� <br /> ISSUANCE. w <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. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER Q) <br /> SETBACK AREA. <br /> 5. <br /> M m <br /> r' 0a0 'O <br /> d <br /> 6. 3 nm Oxn <br /> O ry C N N 0 3 <br /> Z y 0 0 <br /> 7. O . m <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my0c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of W2 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize `: C o my <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- : 1 <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information lam m <br /> providing in this application. I agree to permit county Yficials charged with administering county ordinances or other <br /> authorized person to have access to the above descriW premises at any reasonable time for the purpose of inspection. - o <br /> m <br /> (A m <br /> SIGN HERE <br /> (s net re of or building contractor) f (date) <br /> ZONING ADMINISTRATOR <br /> vi FA v+ <br /> N 0 <br /> Ln O T O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />