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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N <br /> OWNER Ce t�l\9ycJ TELEPHONE 0 <br /> MAILINGADDRESS (7 l ,�b s��Q �Q7eCD <br /> �� £ <br /> CD <br /> r�0 <br /> PROPERTYADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) <br /> CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ V� Cn ° ry <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING 1:1 CAMPING UNIT ,,❑ SUBDIVISION <br /> AGN ❑ T <br /> STRUCTURE/ADDITION USE: /�fY1�fG S l�/Jam/ vA <br /> I'/� ' ,l (Home/Cabin; ommercial Business; Bye room; Deck; etc.) (n2. <br /> W <br /> BUILDING CONTRACTOR: 1\I (10 W <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 p <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> T1 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m v I <br /> cD 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> C 1NORTH(N). . ti n <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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ° <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. Iv <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS Q Q <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> O � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° W <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: n <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. W �� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 1 C <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> X �o �rDODQO -0 <br /> 6. m x6 iim yam <br /> m Cyo 5 3 <br /> 7. <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m — C <br /> PP (� 9 Y ) Y Y � Gu7� ? N , c <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am responsible for the detail and accuracy ofm ° <br /> J <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize ° m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> sue a permit. 1 further accept all liability which may be a res It of the County of Burnett relying on this information I am O <br /> providing In this application. I agree to permit ount offici Is charged with administering count ordinances or other <br /> � <br /> authorized pe son t have ccess scribed j <br /> pre ises at any reasonable time forth ur o <br /> n <br /> SIGN HERE fLO CL <br /> (signatur owne orb ding contractor) (date) <br /> ZONING ADMINISTRATOR ' <br /> to F»to <br /> fA fA Hi fA rj N <br /> O N C l W W N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED BURNETT COUNTY do o u cn cn o <br /> THIS PER <br /> WT SSH�A\LL_ PIRE NN.EyY/YEAAR FROffl DA/_jTj Ems( F I t�/S /A^Ny y�C I. / J([y <br /> ,�'L.1 (t 1 1 4 �C/1 7y 1• at Ut / / ��`t,90 N�VI IS4il,4- 1 V�� r <br />