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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> ^' r <br /> N <br /> 4� C <br /> OWNER ��fs TELEPHONES /- 3�aa� n <br /> v <br /> MAILINGADDRES - / <br /> PROPERTY ADDRESS - `. � r <br /> 10-t a d4-n #3707 v,�X x a <o Joc 35S5'-Z �, /V �' sw 7a wn <br /> LEGAL DESCRIPTION(see tax receipt C I UjdCD <br /> 1 -1 <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ 0 <br /> TYPE OF PERMIT(S): � � o <br /> � <br /> FILLING/GRADING 11 CAMPING UNIT ❑ SUBDIVISION El 9: <br /> STRUCTURE/ADDITION USE: 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) d <br /> v <br /> BUILDING CONTRACTOR: se, F, <br /> S <br /> m O <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 C O <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> O - <br /> A c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: ( ERIAL OR TOP VIEW) O m <br /> n n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T0 <br /> 2. SHOW THE LOCATION AND SIZE OFA L EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m CD <br /> NORTH(N). 1 <br /> 3. SHOW DIMENSIONS IN FEET OF THE F LLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(3)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <br /> LAKE,STREAM OR RIVER AND MEASL REMENT TO WETLAND AREAS. o <br /> 4. SHOW THE LOCATION OF THE WELL(IV),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO <br /> BUILDINGS, ROADS, LAKE,LOT LINES O <br /> 5. INDICATE IF A WALKOUT BASEMENT I 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 O 0 p <br /> MUST BE SIGNED AND DATED BY THE OWNER. W = o`0i t <br /> t°� F <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHENV10 <br /> NEEDED. <br /> 0 Ir G cl <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o ` <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. 69 5 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY fW O <br /> PERMITTED. W <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> s. Em� � � a � � n � A <br /> =rN C y N <br /> 7. Z C i� 0 <br /> P m n [ m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m A <br /> PP (� 9 ) Y Y <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of d C' : c" : C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CD <br /> C m <br /> that this information I am providing will be ielied upon by the County of Burnett Wisconsin in determining whether to is- m W <br /> sue a permit. I further accept all liability wt ich may be a result of the County of Burnett relying on this information I am i 0) o <br /> providing in this application. 1 agree to pei mit county officials charged with adminpOWir m <br /> authorized person to have access to the abc ve described premises at any reason s I (D <br /> m <br /> -n a ; <br /> CD D <br /> SIGN HERE 44i n <br /> signature of ow "r building co tractor) da o' <br /> ZONING ADMINISTRATOR <br /> AUG 1 b X105 <br /> O N Ul W W N O <br /> TOWN BURNETT COUNTY HIP PERMITS MAY BE REQUIRED o " <br /> THIS PERMIT SH 4 E PIR ONE Y ARF O AT OF I U <br /> ZONING <br /> -inn - ��- kl - - �fed "fie Ori `�'C�i rLell <br />