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o r 34 E) <br /> Burnett County 7410 Co. Rd. K, No. 102,Siren,W154872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N <br /> OWNER ; '/Vl �' TELEPHONE <br /> 9Ll <br /> MAILING ADDRESS S 7 T S UVN C-C�,,CO L,3 1- L&(A C �1 L�-0 Y-NA I yj � <br /> m'/ nn <br /> 0 <br /> PROPERTYADDRESS � �(/U! YY j�/ o <br /> LEGAL DESCRIPTION(see tax receipt) LO 1 �— zq Q�j o' <br /> CD <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION Er O <br /> c � <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ R, <br /> STRUCTUREIADDITIONOSE: �� <br /> C,-, 14oxtc 1'11 L� � c(A <br /> (Home///Cabin;Commercial Business,Bedroom, Deck,etc.) cn <br /> BUILDING CONTRACTOR: <br /> CD <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 y <br /> Cr <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 0 <br /> -n v z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE mo <br /> NORTH(N). 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m '0 <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 O <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADE tJL <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CO THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIF TION BE DONE <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c�` ��� o <br /> CONDITIONS OF PERMIT: '7 `,t, q, ^, <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMITO`V�N(� �•YrY 1 <br /> ISSUANCE. C 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Q <br /> PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER J <br /> SETBACK AREA. <br /> 5. <br /> r m d ro co onvv <br /> v <br /> 3 a m s 5 a M <br /> Z N (2 <br /> 7. ° '' ` m <br /> = cn . E A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ,, �j c <br /> 2 <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of W d c, : F» <br /> a c cn m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize O 0 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- �U <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 access to the above described premises at any reasonable time for the purpose of inspection. -n `° o <br /> t & 61 � <br /> � m <br /> SIGN HERE � <br /> n <br /> (signature of r building contractor) (date) <br /> I <br /> ZONING ADMINISTRATOR60 4A N <br /> UN N N <br /> NO O <br /> T 0 N) OO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />