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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v O Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> ^_ r <br /> C y O <br /> OWNER TELEPHONE <br /> MAILINGADDRESS L U)oO 1 Z in ,Qcil _O N! <br /> C� s v p <br /> �/ (J( W <br /> PROPERTYADDRESS 1<Jd� �SLt ! e n 5 yYa i o <br /> :1 <br /> l ou►1`�C, �I r.� <br /> LEGAL DESCRIPTIONsee tax receipt) <br /> � .t <br /> ( p) fat ILl IST erPi,t JIL, .= -I-U L12stf Pine Sw�, 1 <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE <br /> TYPE OF PERMIT(S): /` ❑ ADDITION ❑ o c 0 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> CL <br /> STRUCTURE/ADDITION USE: rrUfre— LCt4� <br /> r-36 "((l 5/ 0 1 <br /> o' Y <br /> (Home/Cabin; Commercial Business;Bedroom; Deck;etc.) <br /> C/) <br /> BUILDING CONTRACTOR: <br /> d <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T 3 <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) A <br /> O m <br /> T o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. � ? <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m v <br /> NORTH(N). CD <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDINGS)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK ING(S) OF � <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD( RS'l TANCES TO ` o <br /> BUILDINGS, ROADS, LAKE, LOT LINES. / <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE RADED I <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILD R, CONTRALTO T <br /> o 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. \ <br /> P41 <br /> NO <br /> F I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VTION MAY B�1E W , o <br /> NEEDED. .. <br /> EAIF)vl�/NE <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ZQ rr cQU/� <br /> CONDITIONS OF PERMIT: NTNG 7y <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ^' I <br /> ISSUANCE. Q t <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY I VN <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER On <br /> SETBACK AREA. C <br /> 5. <br /> 6. mWADaF) 0 ( m <br /> Z H m o : q <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my o T� p <br /> _ N : : m <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of d r`, <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 by the County of Burnett Wisconsin in determining whether to is- <br /> v <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 d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> L -n 0= <br /> SIGN HERE <br /> CD m : <br /> d <br /> own or building contractor) (date) n <br /> ZONING ADMINISTRATOR Q <br /> � Hi EA fA M N <br /> N(TNN O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />