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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator ' o M o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> y O <br /> a 4�f <br /> OWNER Eq� 1 n �oELTER TELEPHONE /s—�S� _ ��$3 0 <br /> MAILINGADDRESS �� AR C)( X95, V rKY. &)T 5y V 30 <br /> PROPERTY ADDRESS C/g qry E��s.TQ� <br /> QC`. S'w sv.r� 5 dr d <br /> LEGAL DESCRIPTION(see tax receipt) St.C, L-p (n <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ m <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVIS ❑ <br /> STRUCTURE/ADDITION USE: CLQ_SIO C3 Y N <br /> o' <br /> (Home/Cat$T, Commercial Business; Bedroom; Deck;etc.) (� <br /> m <br /> BUILDING CONTRACTOR: <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 61/x X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n <br /> -It1 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O 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). y o <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. p <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. O <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 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 <br /> v r <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z ) <br /> CONDITIONS OF PERMIT: o <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 O <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBA K AREA. <br /> 5. 1 `�'e"AI—� U el �" <br /> mW� 0vavv <br /> d <br /> 6. 3 nm Fam <br /> 'O N C n V1 0 j 3 <br /> 7. Z y � o <br /> TM <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of n N <br /> W <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m -a : 0 : m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- \� m v <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am rr , m <br /> W <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 01 <br /> � : <br /> authorized person to have access to the ab a descri ises at any reasonable time for the purpose of inspection. m o <br /> (D m <br /> SIGN HERE <br /> (s na ure of own b ding contractor) (date) <br /> ZONING ADMINISTRATOR ' <br /> 69 69 <br /> fA fA(A(A .+ N <br /> N (TNN O O <br /> (T O (T CTO O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />