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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATIO14 FOR LAND USE PERMITS 3. <br /> r <br /> 57 0 <br /> 96-k -h4X <br /> CD <br /> OWNER IOAWLJJ - Q. �- TELEPHONE �12-� ,1 ^✓ ,,�� n <br /> v <br /> MAILINGADDRESS M5(9lb",Mo. V4', M PL✓r MN � i� <br /> /'�a �O0 <br /> PROPERTYADDRESS l �Q 4,&V-6 �Eso <br /> C9vi. T 4 1 G61M 9& Too f4 4-140V4 �o r 2— oa <br /> LEGAL DESCRIPTION(see tax receipt) � ti <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ C p> o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNITy SUBDIVISION ❑ `{`� °' <br /> STRUCTURE/ADDITION USE: ° <br /> _ <br /> mr <br /> (Home/Cabin; Commercial Business;Bedroom; Deck;etc.) cn <br /> OV4rA � <br /> BUILDING CONTRACTOR: m <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3(I� <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> O <br /> M <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m � �X <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <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 m3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF n ` <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. X� <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. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONT,R ETC., THE PLANS n Y <br /> MUST BE SIGNED AND DATED BY THE OWNER. ��" o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERTr ON MA WHEN S W <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONE LISTED BELOW. e�A QG� \ o <br /> CONDITIONS OF PERMIT: j� �� n\/`jn'L/ (�► <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTHREQUIREMENTS WITHIN 60 DAYS OF PERfjt ,/t'C ��(/? v "( <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE.�'V�C/A,� / <br /> 3. NO GRADING OR SHORELAND ALTERATI NS ARE ALLOWED UNLESS SPECIFICALLY Y <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE R�E/QUIIjRE WATER <br /> SETBACK AREA. i � _ O /fpr SeJb1j) y , /l/j�� / // <br /> 5. S� 6a�K !�v . es'la�li' f'Q r" L�/� ^�- <br /> /� ,�[ O Q m u0i m m a f m <br /> 6. 00 10 �m. 3 a cD O a m <br /> CD C <br /> o Tom € a <br /> m <br /> I declare that this application (including any a companying schedule) has been examined by me and to the best of my �j O <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m F» <br /> PP ( 9 Yaccompanying ) recognizea 0 M <br /> all information contained in this application In ludin an schedule and I further declare that I m o : my <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. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized perso o have access to4heAbovel described premises at any reasonable time for the purpose of <br /> inspection. m o <br /> SIGN HERE rV"C/r <br /> n : <br /> (s nature of owner uildi (date) <br /> ZONING ADMINISTRATOR �7 <br /> EA EA fA�N <br /> N (TNN O <br /> i UtOO <br /> TOWNS P PERMITS MAY BE REQUIRED V U1O U <br />