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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator v c) Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> 5T o <br /> c <br /> OWNER /n� \1 m <br /> �/� �i I-C 1 �✓ <br /> t=7 vOC TELEPHONE - L-I � n <br /> MAILING ADDRESS 3 SS ( �t=�j C3 L FCQ j^�tR I L W R �1 <br /> \� <br /> Lt 1.1 <br /> o <br /> PROPERTY ADDRESS <br /> I <br /> LEGAL DESCRIPTION(see tax receipt) <br /> OR en,,6 &tr 4d 7� <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE M ADDITION rj 0 <br /> TYPE OF PERMIT(S): V <br /> cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ DIVISION <br /> ��// SUBDIVISION <br /> ❑ � <br /> STRUCTURE/ADDITIONUSE: G 44tH 6e CRT OK ✓a- o <br /> _ <br /> n / (Home/Cabin; Commercial Business;Bedroom, Deck;etc.) rn <br /> BUILDING CONTRACTOR: <br /> iu <br /> CD <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. T <br /> O <br /> it N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o \ <br /> 2 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n �o Z <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 mo <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. o <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 /> S. 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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. U3' o <br /> f <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 <br /> NEEDED. T('� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o V) <br /> CONDITIONS OF PERMIT: �} <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. a <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 WATERG� <br /> TBACK AREA. <br /> 5. Q 70 he %o ' Sid,° lot /%rl �7d }yon <br /> 6. I&t /in� — FnY�e Sta-f �-)/y _ CD 11 T 00 o a o <br /> _ � � aFm <br /> 3 a W x <br /> 7. ✓V Wim/ ` f//1 L (J /_ y N O = O <br /> Z <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my —r^ A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <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 permit 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. <br /> m o : <br /> SIGN HERE �� l.t _J�� ut- lu �t`EIO-1— <br /> (signature of o building cont r r► (date) <br /> ZONING ADMINISTRATOR ✓Y, Q/ J <br /> o NU�iNN OO <br /> QNOIT (TOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />