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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 <br /> N <br /> C <br /> N <br /> OWNER/ WN TELEPHONE ^p ^ <br /> MAILING ADDRESS PaAZuwGs <br /> 0 <br /> PROPERTY ADDRESS � <br /> LEGAL DESCRIPTION(see tax receipt) D/ 0 "33,;t�a'731J a 5 3 / -1�o -S//2, �" U) <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION LJ Q o <br /> TYPE OF PERMIT(S): as <br /> FILLING/GRADING ❑ /I p/CAMPING UNIT ❑` ryyS`IUBDIVISION El S. <br /> STRUCTURE/ADDITION USE: �C )_ j' +- 11Sr✓�—' 1 L q cm ' Q ^ <br /> (HomelCabin; Commerci usiness; Bedroom; Deck; etc.) U 1J <br /> BUILDING CONTRACTOR: ° <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O - <br /> -O N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> n <br /> -n Z _ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> n <br /> NORTH(N). 000 <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. N Q <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 /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATIQt�` t SC\t WE WHEN ° �IV <br /> NEEDED. y lil <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS <br /> VIA <br /> . DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERM?Qy QUG� U <br /> r7 t� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Z`�C <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY C � <br /> PERMITTED. 'V ' Y llvJJ <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> �y J /�/� <br /> 5. l/ l 1. <br /> CJ/ RSA 7 m wm r cDi 0n0m <br /> m � 3 yam xa `D A <br /> 6. o c y N o 3 <br /> Z C y O t0 <br /> 7. O N T� A <br /> m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m O <br /> (� 9 Y ) Y Y � EN : C <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of n <br /> all information contained in this application (including any accompanying schedule)and I further declare that 1 recognize <br /> Ma <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 1 am m o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of insCD <br /> pection. T Q <br /> ' ` <br /> -61 adcq <br /> SIGN HERE � n <br /> (signature of owner or building contractor) (date) 0 <br /> ZONING ADMINIS BATOR I <br /> C b9 c <br /> 0 n w 0 <br /> NNW11VO)OUOU (T O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE �� <br />