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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 64872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> F o <br /> c <br /> ,� v 71 - (3s- 7788 a <br /> OWNER �rP ~ pJ—( "0 7�lr lJ 5 <br /> �� TELEPHONE F `, , <br /> r�, 1MAILING ADDRESS J -7 / OD C-0c)A-1l l Rd /q� �� O <br /> r � <br /> 0 <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) SW—�f E + SE—NW I —~ l I v I`�( (� CD <br /> DWELLING/BUILDING 11GARAGE/ACCESSORY STRUCTURE ADDITION ❑ W U) <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑ CAMPING UNIT El SUBDIVISION El S. <br /> A Q T.n <br /> STRUCTURE/ADDITION USE: S r G� 2� G�� ��/ .X C> <br /> ( e/Cabin;Comr#rcial Business;Bedroom; Deck;etc.) rn <br /> / C m <br /> BUILDING CONTRACTOR: <br /> v <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. m <br /> �I N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> 'n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. (� <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m i <br /> NORTH(N). W <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. I o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO 9jI� <br /> BUILDINGS,ROADS, LAKE, LOT LINES. : <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o ( t ) <br /> v vv <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> r <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT (� <br /> ISSUANCE. j ry <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. U I <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 /> 5. <br /> m <br /> 6. ('0 3 & mO0, .'0 <br /> v 02 C W,0 3 <br /> 7. Z N o <br /> o n O <br /> m <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my c JD <br /> C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of O d n e, <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m 0 : 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 d <br /> providing in this application. I agree to permit county officials charged wi Wances or other <br /> authorized person ve a cess to the above described premises at any I t f t u f inspection. ° o <br /> f» <br /> CD <br /> SIGN HERE `✓'" 03 o <br /> n : <br /> (signature o owner or bu ing contractor) " R -a 2003 (d ) <br /> ZONING ADMINISTRATOR <br /> I COUNTY `e `A`"�N <br /> N N O O <br /> ��y <br /> N [TUOO <br /> TOWNSHIP PERMITS MAY BE REQUIR&NINIr- <br />