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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 /> CD{ <br /> TELEPHONE -r�s�2- " z,3 <br /> OWNER O <br /> Tf�f�C -ti 1"r m <br /> MAILINGADDRESS � � �Cir(/ »'h ��ICcL s)1(�� VY� f <br /> 5L18�Y <br /> PROPERTY ADDRESS D2 <br /> LEGAL DESCRIPTION(see tax receipt) I v, <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION rn 0. <br /> TYPE OF PERMIT(S): } c <br /> n <br /> FILLING/GRADING CAM UNIT UNIT [❑� �S/UBDIV(I�SION ❑ � <br /> STRUCTURE/ADDITION USE: S I l e I-1 /J\ 1 O / o <br /> (Home/Cabin; Commercial Business;Bedroom; Deck;etc.) Cn m <br /> BUILDING CONTRACTOR: c.. / <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 /> r1I N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> T a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m CD <br /> NORTH(N). <br /> n <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 Z <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 C� <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. 30 SU <br /> f <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN B <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: 0 <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 /> M <br /> Wr, ODa0 TI <br /> m <br /> 6. $ 3 nm yam A <br /> 7. o y OM <br /> n <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �c p <br /> �; <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of G v, <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize m o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- C t7 <br /> sue a permit. I further accept all liability which may be a result of th Coun of Burnett relying on this information I am cOi <br /> providing in this application. I agree to permit county officials char unty ordinances or other <br /> authorized person to have access to the above described premises a Mculmlhe purpose of inspection. `D <br /> 'n oCD <br /> : <br /> CD <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) <br /> 1 )l.l <br /> ZONING ADMINISTRATOR <br /> --� I SURNE I I COWN I T Gogo?- fqcc <br /> �����NN���� <br /> TOWNSHIP PERMITS MAY BE REQUTREl7' )a60�- - Deck <br /> aaU3s -7 <br />