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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 /> N O0 <br /> N <br /> TELEPHONE <br /> n CJ <br /> EJo/ ��/dle� /dpc &Ir'T Ssy� <br /> MAILING ADDRESS � <br /> C> or <br /> PROPERTY ADDRESS �J a J /�FuSOYl <br /> ( receipt) U �c,fifers � �a h `3 -coo <br /> LEGAL DESCRIPTION see tax ( i.� _L� S m <br /> DWELLING/BUILDING K GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ c 3 <br /> TYPE OF PERMIT(S): ((( (�c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ '� S. <br /> STRUCTURE/ADDITION USE: VP L/ Home,omen � �J 3 <br /> / <br /> (Home/Cabin;Commercial 1us ness; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: � �' S ' <br /> /Zf3 a m� a 3 �d e)- h <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR Qr 1� -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. ✓ „ 0 a (� <br /> I/r c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) /r" n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n !t ? <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m M <br /> NORTH(N). Cn � 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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 0 <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO O <br /> BUILDINGS, ROADS,LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N Q <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. ` <br /> v o, <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. 0 I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> p <br /> CONDITIONS OF PERMIT: `. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT w <br /> ISSUANCE. q, <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 /> m113 <br /> W0) 0MCL :E M <br /> v <br /> -o mCy `" o � 3 <br /> Z <br /> 7. o -n� m <br /> =(n: A <br /> declare that this application(including any accompanying schedule) has been examined by me and to the best of my , c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o a <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize (� m m 0 : rn <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- N <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to ha access to the above ribed pre isea at i r the purpose of inspection. T m 0 : <br /> CD <br /> SIGN HERE ` n E <br /> (signal e o owner or bu i contractor) r'n_ (date) <br /> 2 : 2002 : : . : . <br /> ZONING ADMINISTRATOR G ' 6 re <br /> Q d!EA EA VI N <br /> N U t N N 9PO O <br /> R� � � NO(T (TOO <br /> TOWNSHIP PERMITS MAY WTtU 60UNTY <br /> ZONING <br />