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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ' o �io <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> ^� r <br /> HE- <br /> N <br /> C <br /> TELEPHONE <br /> OWNER I ' (�� <br /> MAILINGADDRESS 05D3� aiugUER %�)alM 'Rd Sp(Dootsj IE 2 11 5100( CD <br /> r <br /> PROPERTYADDRESS <br /> I" <br /> LEGAL DESCRIPTION(see tax receipt) �� 9^ (/ M <br /> M <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ rn o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> N <br /> t.i� <br /> STRUCTURE/ADDITION USE: T7C�✓Yo p t <br /> om Cabin; Commercial Business; Bedroom; Deck;etc.) y <br /> `vj✓ <br /> BUILDING CONTRACTOR: " 717 (1 <br /> m fV� <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN SYz X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m — <br /> M w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O `m <br /> T a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> 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. ( 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. 0<31' :E <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 /> ,o o ) <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN .�'» o, W <br /> NEEDED. n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: 0 J <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT _'C.J <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 L/v <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> A ter DODO -0 <br /> m an d 0 0 n � m <br /> 6. m3 am yam <br /> O N C y N O 3 <br /> 7. Z Ngo . -t <br /> O -nM <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ID <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of G v, <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize � <br /> CD : o v <br /> CD <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- �J <br /> \ ci <br /> sue a permit. I further accept all liability which may be a result ofthe Cp ,retylind on this information I am u <br /> providing in this application. I agree to permit county officials charg ) Ei <br /> s�oringOotlnty ordinances or otherauthorized p on to have access to the above —n a remises at y sodtiitrie for the purpose of inspection. m s <br /> mo : <br /> t .�9 2y�2 d <br /> CD <br /> SIGN HER a <br /> jw9ridwiv of o building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> (fl 61 fA fA N <br /> N OI N N O O <br /> t r '•L,I U1 O (T (T O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />