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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 /> r- <br /> N O» <br /> N <br /> C <br /> , N <br /> OWNER /) /_., TELEPHONE <br /> MAILINGADDRESS �f 7 N <br /> 9351 1D2 CT l•U�d�fSy�f� //9•y. S/moi <br /> r � <br /> �y r 0 <br /> PROPERTY ADDRESS Z 7J Y � AV �6- Rd Ad e�1 Alt 5Y O'30 <br /> LEGAL DESCRIPTION(see tax receipt) 0� �(� y lNr� CS ( <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> © X y oaQ SN <br /> STRUCTURE/ADDITIONQSE: <br /> > <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) rn <br /> BUILDING CONTRACTOR: 641574j� m <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. n <br /> O <br /> Xl m (� <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0m X <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). 06 0 <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 V r-_ -Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. t p <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO p <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. U} N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERI o <br /> NEEDED. 0 Q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CS <br /> JU <br /> CONDITIONS OF PERMIT: N 1 7 o 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT vErr C <br /> ISSUANCE. OUNTY <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELIN?ONING <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. n <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER lW <br /> SEETTBAA�C�K-IAREA.5. / /n <br /> ^ 0 OidMCL:E m <br /> u0 <br /> 6. ID C: <br /> 7. 0 . 9' 3 <br /> "' 1 � Z inmx '01 <br /> P ii'� 7J <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my — (n A <br /> Q C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of i'u n : (A <br /> PP (including Yaccompanying ) 9 0. ~ ' M <br /> all information contained in this application mcludin an schedule and 1 further declare that I recognize � <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 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 tq have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> -n <br /> m o m <br /> SIGN HERE foJlfIts `A C <br /> (signature ature of owner or building contractor) o <br /> ZONING ADMINISTRATOR <br /> fA fA 6A(A(A N <br /> N T N N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED C;? ?QC A41 o cn cn o 0 <br />