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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. a <br /> N <br /> N <br /> c <br /> fD <br /> �/ d <br /> OWNER TELEPHONE 6S�- 7 J 7 c�Y <br /> CD 0 <br /> MAILINGADDRESS Cf Z-4vf/ e/t7ul� (H j7 11 ` . m <br /> PROPERTY ADDRESS G p� )e'.., y \ Q I 3 f r o <br /> LEGAL DESCRIPTION(see tax receipt) t <br /> o <br /> DWELLING/BUILDING ❑ GARAGE CESSORY STRUCTUR ADDITION c <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT SUBDIVISION ❑ m <br /> STRUCTURE/ADDITION USE: ��C rn <br /> (Home/Cabin;Commercial Business,Bedroom,Deck,etc.) � <br /> BUILDING CONTRACTOR: <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 m <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n cL <br /> o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n ° A <br /> m T <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C O <br /> NORTH(N). to <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDINGS)TO m v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF o <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 r,� <br /> BUILDINGS, ROADS,LAKE,LOT LINES. N <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 �, o ) <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> ' g — <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATIONitl�A1� 1 ' <br /> NEEDED. ! <br /> i� 14A y _ v q Z a <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: 'S p'V )L/ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMI76 4WCO(J" <br /> ISSUANCE. LL �' T <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <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. `_ 5 <br /> / _/�3f� 3 A O r p o D O 'o <br /> tr I ma�7Gtteti aT I'v" v d n f m <br /> f�// /� Pl 3 n m a m <br /> 6. e J,-6�e f /'7 re <br /> �Cd"nYf7 �6 1 v 0 � wr�� C6a1��e� Ze Z CD <br /> 7. (dI`� sae ? �7 N �S IU o -n m <br /> — cnA <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G5 C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o m - : o : m c y <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CD <br /> : : 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 <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. <br /> CD <br /> m <br /> SIGN HERE <br /> n <br /> (signature of owner or b ng t d <br /> ZONING ADMINISTRATOR vi<A 0 N <br /> N N N N0 O <br /> Cn0 (li cn00 <br /> TOWNSHI PERMITS MAY BE REQUIRED363 <br />