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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator -0 G) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> to O <br /> C VCJ <br /> OWNER oou k I I n& TELEPHONE 763-`y7 7-6Y6 y p <br /> mO <br /> MAILING ADDRESS ,C O 41 P S I I eJA Al- <br /> S S fl I <br /> n <br /> PROPERTYADDRESS �l eG( -40- , <br /> I <br /> LEGAL DESCRIPTION(see tax receipt) LO+ 3 C2 /n <br /> roai �d ,14\ IyeytWv<<" '1WmJ6.,wisc. <br /> DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ❑ ADDIT1:1ION <br /> �T ,C rn 0 <br /> TYPE OF PERMIT(S): �►a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISIONS. <br /> ❑ <br /> STRUCTURE/ADDITION USE: t I OM C 0 <br /> (Home/Cabin,Commercial Business; Bedroom; Deck;etc.) rn <br /> BUILDING CONTRACTOR: I hL C l OASTYUC I id/1 <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 /> A � <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o T—� <br /> T y Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. (� 0 A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 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 3B <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. o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO 1 C� <br /> BUILDINGS, ROADS, LAKE, LOT LINES. 31 <br /> S. 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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> v, <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. 0 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z y <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Oo <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. V( ) <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> CD uOiw0Cad m <br /> CD C: 3 <br /> 7. <br /> I 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 I am responsible for the detail and accuracy of <br /> CL n .� <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m O . m <br /> that this information I am providing will be relied upon b the County of Burnett Wisconsin in determining whether to is- CD <br /> P 9 P Y tY 9 G) : <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 v <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. `D CD o <br /> m m <br /> SIGN HERE lI/ '491 —03 <br /> CL : <br /> (signatur own r or building contrac j� (date) <br /> ZONING ADMINISTRATOR i / t Q'r�� Q) <br /> �r) <br /> fA EA fA En N <br /> N 4 N N 0 0 <br /> ^ Ui ON CTOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED V�J <br />