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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 (f) <br /> VT o <br /> I �f <br /> OWNER �'O�.I� t �� o-� TELEPHONEv <br /> pa 1 IIp m <br /> MAILINGADDRESS �� !O b � r11J26s�W lS ���(J /� v O <br /> r � <br /> � / / 0 <br /> PROPERTY ADDRESS �78�3 (�N �l 7- �e.65Tt-� GC�i3 s��'93 <br /> I _u `/ <br /> LEGAL DESCRIPTION(see tax receipt) . s25- (p_�to 56ed O-" t /,3' ��/V� m <br /> IIQ�(( <br /> 2 <br /> DWELLING/BUILDING'K GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑' N o <br /> TYPE OF PERMIT(S): ` <br /> v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: r Q <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) rn <br /> m <br /> BUILDING CONTRACTOR: <br /> 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. 't <br /> O <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> T <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 9 <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> a <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ( o <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. C� ` <br /> I <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. NCD <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 F <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN g <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Zp ) <br /> CONDITIONS OF PERMIT: 771 <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. <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 /> � dd0 ° afm <br /> 6. x3 nm 0L' w <br /> 0 omC �, <br /> Z C N ry O -i <br /> 7. O N Tom ' m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m — r^ ' O <br /> PP ( 9 Y ) Y Y !7 c p C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m ` i m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether O <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this inforI am m <br /> mation o <br /> providing in this application. I agree to permit county o ials charged with administering county ordinances or other ,o E <br /> authorized person to have access to the above describgArptemises at any reasonable time for the purpose of inspection. <br /> m E <br /> m D <br /> SIGN HERE s�'Gt'G" ✓Y�J� O6 oZ O n <br /> (signature of owner of building contractor date) 0 <br /> ZONING ADMINISTRATOR 1(Yl ( <br /> inL <br /> o LA o <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ON YEFROM DATE O�SSUANCE <br /> Perm t + bet& ,5 ve r�2st �-IIfo <br />