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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 /> a o <br /> N <br /> C <br /> OWNER �on �- \CI kSC�✓! TELEPHONE /- `/3�. y9g o <br /> (D <br /> MAILING ADDRESS 3C (� w ( ( �/� of �� M� 0 <br /> 1 / /-7 <br /> PROPERTY ADDRESS p�vy L/tK{G � Cha-w i 1 uZ Lka� I <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ bi 0) , <br /> TYPE OF PERMIT(S): \ v 0 <br /> CL <br /> FILLING/GRADING ElCAMPING UNIT ❑ SUBDIVISION <br /> (❑ �ko <br /> STRUCTURE/ADDITION USE: 5/14f �A�• C ���c. J� �� 'L c�Pr� 0 <br /> (Home/Cabin; Cbfnmercial Business;Bedro eck;etc.) ro (� <br /> BUILDING CONTRACTOR: Pv ✓� ,� d <br /> v <br /> m <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 /> �I N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> m <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). y 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 <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO ( I O <br /> BUILDINGS,ROADS, LAKE,LOT LINES. V\ <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 XJ <br /> MUST BE SIGNED AND DATED BY THE OWNER. i/y 0 <br /> � ' 10 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFIC W -y» o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. FEBj ..0 <br /> CONDITIONS OF PERMIT: pL� J <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERIRVRNETT COUNTY OO <br /> ISSUANCE. ZONINS Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n o <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY j 11I <br /> PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER �t <br /> SETBACK AREA. ^ <br /> 6. 8 3am X CL <br /> O ry C N O 3 <br /> 7. Z N O <br /> G On <br /> 1 declare that this application(including any accompanying schedule) has been examined by me and to the best of my C <br /> knowledge and belief it is true,correct and complete. I acknowledge that Lam responsible for the detail and accuracy of m n v, <br /> O ^ N : it <br /> all information contained in this application(including any accompanyi e)and I further declare that 1 recognize (D 0 : m <br /> that this information I am providing will be relied upon by the County nsin in determining whether to is- m <br /> sue a permit. I further accept all liability which may be a result of the ou f ing on this information I am m <br /> providing in this application. I agree to permit county officials char ed with my ordinances or other o <br /> authorized person to have access to the above described remise an re its <br /> e" m N <br /> P premises Y Pur ose of inspection. - o <br /> ( w <br /> SIGN HERE Lr - 'y T C/u y�ii r��.- ��/t�. p 18 \i9' /l A 3 d' <br /> (signature of nor or buii contractor) n <br /> / : .(date) <br /> ZONING ADMINISTRATOR t I �C _ E <br /> 0 N 0N O <br /> {,, �'/ed 4V e / TOWNSHIP PERMITS MAY BE REQUIRED .S u <br />