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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator -U G) z <br /> APPLICATION FOR LAND USE PERMITS 3 �XJf <br /> UT 0 <br /> N <br /> OWNER TELEPHONE 16 a" <br /> a9 0 <br /> MAILING ADDRESS 13 1-1 gamCD <br /> PROPERTYADDRESS pt°)7fSufa Q� S <br /> l ! )C41 C5711 A <br /> � <br /> LEGAL DESCRIPTION(see tax receipt)FrA 6( j 3 SGG 35 `r Llb IV R]SW <br /> DWELLING/BUILDING.X GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ I rn <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT 11 SUBDIVISION ❑ �/ a <br /> STRUCTURE/ADDITION USE: 46 © C 1/' - l 0 <br /> (Home/Cabin Commercial Business; Bedroom; Deck;etc.) rn <br /> n,�r soh <br /> d 1 <br /> BUILDING CONTRACTOR: lam• �A 4d'T��� °1 <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. T <br /> O <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> T a <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. � <br /> n d � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C 0 <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 <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 1j\0z <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. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC., THE PLANS j o <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> C v .� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHENp, 0 o <br /> NEEDED. J - <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: 1 <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 /> 6. !31d i/ L l;l� N N n v a O m <br /> 3omOw D <br /> 'O^ N <br /> 7. JUL 222002 <br /> Z " " <br /> declare that this application(including any accompanying schedule) has been examined by me and to the best of my cj p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am res QQ�� ����� ,t�!I s�.�§curac of d fA c <br /> all information contained in this application(including any accompanying schedulej31aVV ft de�E� �tYrecognize m o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin i ing whether to is- p m 0 <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information1 am G <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person toAve a ess to the ab ve descr[b!Afflmises aany reasonable time for the purpose of inspection. m Cl) <br /> T CD O <br /> CD <br /> SIGN HERE (A <br /> EA iu <br /> C : <br /> CL :: <br /> (signature caner r building contract (date) <br /> ZONING ADMINISTRATOR <br /> (A69 <br /> fA EA EA fA.+ N <br /> N N N N OO <br /> tT O (T (T <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0O <br />