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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator v 0z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> n �f N <br /> T 0 <br /> OWNER me TELEPHONE <br /> MAILINGADDRESS /`!✓�� � jtt� � �tJ ��SS` 0� <br /> ,,.���//I <br /> PROPERTY ADDRESS eZ Oqy /��y�Lo� ,(� S//Zejt/� lot,/' <br /> J <br /> LEGAL DESCRIPTION(see tax receipt)IQ 3 q 2p,r` e I b C�r,3D`tWct, SSeS, P��1 OT 1-3 `Jv m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION Schr�1 /��-K co <br /> TYPE OF PERMIT(S): v ' <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTUREIADDITIONUSE: �g//✓111—��` Q�� S�cpve A-4 -to <br /> L S . ? 4) <br /> (Hom a in; Corcial Business;Bedroom; Deck;etd.) cn <br /> �^ m <br /> BUILDING CONTRACTOR: SQ �T I d <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR El <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. Q I / }�J T <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) Uerlt 9-oti0'�� O n <br /> V 0-1P, T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. a <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). W 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. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CoxTRACTOR, ETC., THE PLANS o <br /> MUST BE SIGNED AND DATED BY THE OWNER. I <br /> ) S �r 4 1 r <br /> ��lJ_/lar1 �', o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERT IC O l ib O <br /> NEEDED. i (� <br /> APR 2 3 20Q3 ' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o G <br /> CONDITIONS OF PERMIT: C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIBURT COUNTY / <br /> A <br /> ZONING <br /> ISSUANCE. O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. G <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 /> 6. 3 am sa * ;u <br /> "O N C Nj N O 3 <br /> 7. z Nm0 ' q -I <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of myG) ca c <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of d .n <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize m : o : m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <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 rw : o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. mCD <br /> o <br /> m m <br /> /5�n3 <br /> SIGN HERE A06*-X <br /> (signata of wger or building contr to (date) <br /> ZONING ADMINISTRATOR <br /> F»Fn v+ <br /> N Ut N O <br /> to O u <br /> TOWNSHIP PERMITS MAY BE REQUIRED i <br />