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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 j <br /> N <br /> OWNER d`{1 // /l u TELEPHONE & ` -- 2117 <br /> / �O <br /> MAILING ADDRESS �a, 2`�-y�t✓f. �� V ��(h vd �� �C�f r CD <br /> O <br /> PROPERTYADDRESS <br /> LEGAL DESCRIPTIONsee tax recei p)�t <br /> t / / <br /> DESCRIPTION(see Tiy� SIO Rib Set .0I (D ((�� <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ N <br /> TYPE OF PERMIT(S): <br /> C <br /> c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑�`l1S�UU BBDIVI�SIIOO�NjJ❑ ' <br /> STRUCTUREIADDITION USE: 6 f A-,K 6 w <br /> J[ J /y • — 4 <br /> Cl (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) cn <br /> n m <br /> BUILDING CONTRACTOR: ef CIA 5 44 W G f�I ti io <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/z X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> it N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 4 a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. A m :b <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). (n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m ` 3 <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 <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. =o C <br /> o = I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> I <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. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5, m a) chi CD of m <br /> 6. 1 m 3nmO ° <br /> a mCy ' o � 3 <br /> y W o <br /> 7. o CID <br /> T� A <br /> m <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my c c <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of m d, <br /> Q. cn : <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m o my <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 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. m m o <br /> [�/ �/ ! / �t m m <br /> 119 <br /> SIGN HERE W I� /7�I, (D —d 4/ 0 <br /> a : <br /> (signature of owner or buil ' ontractor) (date) <br /> ZONING ADMINISTRATOR <br /> 169,69 <br /> lfl fA EA EA � N <br /> N (T N N O O <br /> (TOUT (nOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />