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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 3e. <br /> N O <br /> ►\ 1 CID <br /> OWNER 1 )tom N rJ ( L\7 c TELEPHONE ✓�b3—Z�^��bc� o TVA <br /> MAILINGADDRESS � ��y �a�o�� V/XLLEtjr Lge�+ �q�l l �� ? <br /> PROPERTYADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) 1�W Yy S->T tUIJ 30 T 40 N-R\1 W <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ In O <br /> TYPE OF PERMIT(S): p Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ �T IEQS <br /> N <br /> STRUCTURE/ADDITION USE: 5 <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) rn <br /> m <br /> BUILDING CONTRACTOR: M S L C—LL t o kt C e rJ�stYl' � LLvJ m <br /> v r <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> � y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 4 0 _ <br /> -n v Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 0 <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 0 <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. 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. 0 <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN FA 0 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> 0 <br /> CONDITIONS OF PERMIT: \ <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. <br /> 3 NOGRADING <br /> OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> X di)0Ma � m <br /> 6. 3 OR yam A <br /> -o Cy " 'o' � 3 <br /> 7. Z N N O t0 <br /> m <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. I acknowledge that 1 am responsible for the detail and accuracy ofm n F»: <br /> CL E v, : M <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m O : mG <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 I am m <br /> providing in this application. I agree to permit county officials charged with administe ordinances or other o <br /> authorized person to have access to the above described premises at any r�� �rpose of inspection. -n ° o <br /> CD <br /> nn m <br /> X ' <br /> SIGN HERE �\ �• L � 2QOZ a <br /> (signature of owner or building contractor) OR 3 U ZUuz (datef <br /> ZONING ADMINISTRATOR TIM F101430 <br /> EA Ln EA Pi 0 N <br /> -BU�RNETT COUNTY d 5�3C�-N� N 0 N N 0 0 <br /> NfTN00 <br /> TOWNSHIP PERMITS MAY BER IREPONING <br />