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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. Q ' <br /> r N <br /> N O <br /> CD <br /> OWNER e��,� �"G¢a�,f / �s.S�I'y� TELEPHONE 0 0 <br /> MAILINGADDRESS /eo 2 <br /> Ille <br /> //' r � <br /> PROPERTY ADDRESS "7 /Ao /7A-411C �� o <br /> _r T <br /> LEGAL DESCRIPTION(see tax receipt) <br /> rK <br /> DWELLING/BUILDING :�g GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ p> > V <br /> TYPE OF PERMIT(S): nye' Q <br /> FILLING/GRADING ❑ CAMPING UNITY ❑ SUBDIVISION ❑ I n Q <br /> T. <br /> STRUCTURE/ADDITION USE: O a 0 <br /> om abin; Commercial Business;Bedroom; Deck;etd.) <br /> J ° <br /> BUILDING CONTRACTOR: w <br /> ' 1 <br /> -o <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 C <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). N 1!3-11 o <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 Cep Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 9 <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. �. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N 1• <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS 0 W <br /> MUST BE SIGNED AND DATED BY THE OWNER. = <br /> f <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATIONN;IdA �E DONE WHEN o ) <br /> NEEDED. i`^ �J <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: l �* \ <br /> C� qP# <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PEWIT <br /> ISSUANCE. A, <br /> 2 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHOREL NN' Z VAC <br /> 3 NO GRADINGED. OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY CO2D/V� UNIy <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. �J d-f <br /> 6 <br /> (gyp C <br /> 7. Z N N O O O <br /> T� m <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 0 A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m 0 : v, <br /> N : <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize <br /> CD m o : M m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- v <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 o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> mo : <br /> co m' <br /> SIGN HERE d' <br /> a : <br /> (signet o~ wne b td rector) to r <br /> y� p <br /> ZONING ADMINISTRATOR <br /> to Ne <br /> 4 VI EN fA fA N <br /> ^ N OI N N O O <br /> �(TO (T (TOO <br /> OWNSHIP PERMITS MAY BE REQUIRED <br />