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Burnett 0;unty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administratorm o 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> N <br /> / <br /> d <br /> OWNER / /�0�0� TELEPHONE 5d— - —S m tt <br /> O <br /> MAILINGADDRESSCD <br /> ����s J�� CT �p '/� �1�ir� ']'S �i✓ c Z <br /> PROPERTY ADDRESS 3Yo 441 <br /> LEGAL DESCRIPTION(see tax receipt) CSm <br /> 1 9 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION A Q y <br /> TYPE OF PERMIT(S): I {� cr <br /> STRUCTURE/ADDITIONRUSEFILLI�GRADING ElCAMPIN UNIT ❑ SUBD�ISI ❑� {�� fl�// /© <_• f� <br /> o' <br /> - / (Ho /Cabin ommercial Business; Bedroo ; Deck; c.) c <br /> BUILDING CONTRACTOR: /I <br /> Z <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 m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n <br /> �1 O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m `� jp <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE rn n <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 /> 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. <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,CONTRACTOR,ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. U' pe, <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFIC, E WHEN y» <br /> lvi �. <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ✓ 0 1� <br /> CONDITIONS OF PERMIT: ( U� ) <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PE B ���A,F �CV* l <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE?Q Fou <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ��� iIlj�, <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBA5. �s 1 1 `-REA. ` C �,�dl� �J l u� <br /> j� m 0)WWgm- <br /> 7. <br /> 0 -0 <br /> 3 a6. mvw m c <br /> Z <br /> __CD m <br /> I declare that this application (including any accompanying schedule)has been examined by me and to the best of my t C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of w i <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m rn <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- i ^:s: <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 i <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to access to the above described premises at any reasonable time for the purpose of inspection. m c <br /> CD <br /> CD m . <br /> SIGN HER -/ _O I <br /> CL <br /> (signatu f ownt!!oAiuild contractor) (date) <br /> C: <br /> ZONING ADMINISTRATOR4940 to <br /> l <br /> TOWNSHIP PERMITS MAY BE REQUIRED � <br /> �a� HIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE S <br />