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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. <br /> r <br /> y O <br /> c <br /> OWNERJ/M G C✓LL�1/�o�� TELEPHONE 763 s3-� -' `Y Y 7 7 e <br /> / � A/ o/J <br /> MAILING ADDRESS f <br /> r � <br /> PROPERTY ADDRESS 3 I T YV i/�(� �/}t� ✓✓ r <br /> 1 \) <br /> LEGAL DESCRIPTION(see tax receipt) S 12 7 !�// IV-1Z IY� Q <br /> DWELLINGIBUILDING ❑ GARAGE/ACCESSORY STRUCTURE [ �ADDITION ❑ (/> <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING�❑ CAMPING <br /> /U11JNIT SUBDIVISION ❑ �. <br /> STRUCTURE/ADDITION USE: /�/�f7� / /)i/riK �+J1/SIF/ ° <br /> / Ao Cabin; Commercial U <br /> �//ercial Business; Bedroom; Deck; etc.) C <br /> BUILDING CONTRACTOR: / / /OfI�Y, LS 4/) L'0 1� <br /> U <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8Yz X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> n <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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 <br /> BUILDINGS, ROADS, LAKE, LOT LINES. IS) v <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. IV <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. q <br /> f <br /> o n <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o V) <br /> NEEDED. (�) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o N <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. q <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. <br /> 5. <br /> r D O n 0 <br /> 6. <br /> omC: o � 3 <br /> Z c o 1 <br /> 7. o <br /> - �» in O <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of C J: w' n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m c m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- U) : C <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 o <br /> providing in this application. I agree to permit county officials charged with admin's r m <br /> authorized per have acces to the above described premises at any reasons¢ i t n <br /> T7 d <br /> CD aCD <br /> a <br /> SIGN HERE to - <br /> na re oown y uil ng con Factor) (dat + <br /> AR 2005, o <br /> ZONING ADMINISTRATOR <br /> SURNETT COUNTY <br /> TOWNSHIP PERMITS MAYBE REQUIRED <br /> ZONING 0 �oN � � o <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DAT OF ISSUANCE <br /> i�f-r rn�-I- 4- I e--I-4-c-r moL I L d -M DATE <br /> (hcC'' L4L l I b cq k <br />