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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 /> UT 0 <br /> SU <br /> e ^nn y� / N <br /> OWNER n <br /> TELEPHONE <br /> m <br /> MAILING ADDRESS a�s8 AEn%d�/ P/gfle ��ti A4kcs l In A/ SSS/i/ <br /> r m <br /> PROPERTY ADDRESS a 7 C 7 Ye//p&d-) AA f-c /) 1 (begs r- � <br /> �C �e�p kQ <br /> LEGAL DESCRIPTION(see tax receipt) Cas T IVO It /7 /—,97- <br /> DWELLING/BUILDING <br /> LOTDWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ® o <br /> TYPE OF PERMIT(S): p I <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ q � <br /> STRUCTURE/ADDITION QSE: 7 itb /A7 ft n k-3 o_ Q I <br /> (Home/Cabin; Commercial Business;Bedroom;Deck;etc.) Cn v l <br /> m <br /> BUILDING CONTRACTOR: "k- Arn U NdS fils <br /> A8 '- <br /> 12 y <br /> 'o <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n 3 <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 C \ Q <br /> T 2 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T ? <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE n v <br /> NORTH(N). m CDC <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m N t <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF V 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 W <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <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. ID o <br /> o <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 (n <br /> CONDITIONS OF PERMIT: II' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> N <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 O a <br /> PERMITTED. Qlj <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> � <br /> vet ' aD0M <br /> s. N W N d n m a * m <br /> 3 a o O a <br /> m �r _ 0 <br /> 7. <br /> N N p <br /> O T 12 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my � - y A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofll m n ' w c <br /> KJ <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m a 61 m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- `D <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 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m s <br /> o : <br /> mm <br /> SIGN HERE <br /> (signature o ner or building contraa <br /> (date) <br /> ZONING ADMINISTRATOR / <br /> p ^ 'n� fO 8 EA Ej O N <br /> f 1`!ll NO <br /> NNOO <br /> (T O (T (P O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />