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349-c-;' 13 <br /> 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 /> Vl <br /> h <br /> OWNER TELEPHONE ',/s O <br /> m <br /> MAILINGADDRESS�9` 6 0Ar M l ti <br /> M <br /> PROPERTY ADDRESSt 6evJ dQi <br /> / D -Ab(•.r <br /> .Z <br /> e, <br /> LEGAL DESCRIPTION(see tax receipt)1J/� r`n �0 1Z -^O 00szv CDC <br /> DWELLING/BUILDINGGARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ �.J (/> ) <br /> TYPE OF PERMIT(S): 11 a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ S. <br /> N <br /> STRUCTURE/ADDITION USE: 0 r <br /> (Home/Cabin; Commercial Business;Bedroom; Deck;etc.) U) <br /> BUILDING CONTRACTOR: f 7Y1� <br /> 42 <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR E <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> it N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> InZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 15109 CENTERLINE OF ROAD,(C)BUILDING(S) EASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OFLAKE,STREAM OR RIVER AND MEASUR MENT TO WETLAND AREAS. <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO I <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED B AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATIO HEN <br /> NEEDED. n' <br /> i <br /> THIS PERMIT IS SUBJECT TO ALL CONDITION LISTED BELOW. o. \\ <br /> CONDITIONS OF PERMIT: A�/1 0 <br /> t ISSUANCE.MUST MEET DRIVEWAY WIDTHREQUIREMENTS WITHIN 60 DAYS OF PERMITU/9NF O 2 6202 kj� <br /> 2. REMOVAL OR CUTTING OF TREES AND <br /> �- <br /> 3. NO GRADING OR SHO ELAND ALTERATIONS NS ARE ALLOWED UEGETATIOISRNLESS ICTED SPEC F CAALONGORY LINE. ?O CO \1 <br /> PERMITTED. 8 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. l <br /> f` ry0QO -0 <br /> CD Wm <br /> 3 n m x <br /> 6. o m C N " o <br /> 7. Z in o ' 'o <br /> o �t X <br /> I declare that this application (incInn <br /> luding any accompanying schedule) has been examined by me and to the best of my — °' (J <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of <br /> d e, C <br /> OCL a v <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize co m : O : fnv <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 m <br /> providing in this application. I agree to perm t 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. m o <br /> CD m' <br /> SIGN HE <br /> a : <br /> ( ' ure of owner or b ' in ontractor) (date) <br /> ZONING ADMINISTRATOR �{f� <br /> O fA fH(fl fA�N <br /> N N N N O O <br /> TOWNSH P PERMITS MAY BE REQUIRED N <br />