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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 /> OWNER �� \ STPDK-C-- TELEPHONE Cf S2— q74-322( n <br /> � 7 <br /> MAILING ADDRESS S33 (2OWLk*,r,) 1e-up�&>/ M IfVNICIM"lce•IT A f�j 4;s-,>q�j O <br /> r � <br /> / LA-r— <br /> O � <br /> PROPERTY ADDRESS Z(DO�� Ci/1 j j 0ASS �'I— T)Q\Q6, M�7rbN W I 1 <br /> LEGAL DESCRIPTION(see tax receipt) 0 cn C <br /> CD <br /> c7I' 1 0 ..--11.. <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE I ADDITION ❑ (Z;;, (n <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING ElCAMPING UNIT ❑ SUBDIVISION El '"'I-"�a <br /> m' <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> m <br /> BUILDING CONTRACTOR: C C�RAMf3C�RCr u <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. -n <br /> O y <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o. <br /> In <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S)TO m3 <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. P <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 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0 I'' <br /> MUST BE SIGNED AND DATED BY THE OWNER. o o if ,/� <br /> o � W <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. Z <br /> CONDITIONS OF PERMIT: o w <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <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 /> X co Or D0 D0 M <br /> m c m m 0 m n f M <br /> 6. CID <br /> X3 n2 yam <br /> o m (Zy �' o 3 <br /> Z c rn C O 7 O 1 <br /> 7. o m -n`� <br /> = m : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of myis-Ili to <br /> : A <br /> G) : � : c <br /> knowledge and belief it is true, correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of <br /> PP (including Yaccompanying ) g ' <br /> all information contained in this application Includin an schedule and i further declare that 1 recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- S m <br /> U) : t7 <br /> sue a permit. I further accept all liability yfhIch may be a result of the County of Burnett relying on this information I am d o <br /> providing in this application. I agree tormit county officials charged with administering county ordinances or other :' o m <br /> authorized person to ace tote b ve described premises at any reasonable f ° a <br /> m <br /> m n . <br /> SIGN HERE n '• <br /> (signet re f owner or building contractor) (date) I i 0 <br /> , I <br /> ZONING ADMINISTRATOR L+ <br /> ovON) r0NOWWN o <br /> TOWN <br /> 0000000 <br /> SHIP PERMITS MAY BE REQUIRED [3URNETT COUNT <br /> LINTY <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUAMNG <br />