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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 . <br /> y O <br /> CD41 <br /> C <br /> WIRJER L] /E �+ TELEPHONEv <br /> 791 3 a <br /> CD Oo� <br /> MAILING ADDRESS L 0 8 Y K/ PE A- l/� ��� � ��, f <br /> 4s� <br /> PROPERTY ADDRESS 8 y ^ <br /> LEGAL DESCRIPTION(see tax receipt) LOT- '/ c'70✓ i yr Z Sea r fg 7— �o /u l\ /y W `�1 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION 0 <br /> TYPE OF PERMIT(S): o <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> N <br /> STRUCTURE/ADDITIONOSE: Ali d/NCS JO O ilq ICA Z fe 0 <br /> I <br /> '/ Q <br /> (Home/Cabin; Commercial Business;Bedroom; Deck;etc.) rn <br /> BUILDING CONTRACTOR: iG ifs USS p LJI 'LO/4 4 d 0��t, 42 <br /> il! <br /> M <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a ZZI <br /> T <br /> n 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 CD <br /> NORTH(N). C k3:3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDINGS)TO ALL LOT LINES,(B)BUILDING(S)TO mCENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <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. Q <br /> 5. 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 PLANSJj <br /> MUST BE SIGNED AND DATED BY THE OWNER. o 0G4 <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. 2 <br /> ti <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 Q4 <br /> ISSUANCE. P k V <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 /> 6 <br /> SETBACK AREA./ \d STRUCTURES, INCLUDI���.-� LL�'ALLOWED WITHIN TREQUIRED ER <br /> K02 % ( m oor' > 0D . f m <br /> 6. 3 nA Ox ft. m ;a <br /> a <br /> 'c' C N N o <br /> 7. Z y M 0 : 0 <br /> o T4 : ;D <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of myc c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> PP (including Yaccompanying ) 9 W <br /> all information contained in this application includin an schedule and I further declare that 1 reco nize C o v <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 acqeps to the ab9fe dpocrib remises at any reasonable time for the purpose of inspection. m <br /> r o : <br /> ` m m <br /> t <br /> SIGN HERE '^ <br /> n : <br /> (signatur of r or building con tr (date) <br /> ZONING ADMINISTRATOR <br /> �� EA fA EA <br /> N U t N N O O <br /> TO SHIP PERMITS MAY BE REQUIRED 031 (TO T (TOO <br />