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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> OWNER /''1/��/' J!�` �` TELEPHONE�g�� ) <br /> O <br /> MAILINGADDRESS <br /> r m <br /> �. o <br /> PROPERTY ADDRESS ti \ <br /> t <br /> LEGAL DESCRIPTION(see tax receipt) <br /> 2 1 ` <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ to <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ �' <br /> STRUCTURE/ADDITION USE: ( r o 0 <br /> L�C+� <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) Cn <br /> BUILDING CONTRACTOR:/�1A <br /> -o <br /> CD <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 /> ,ZI N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> -n O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m X <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m —9 (" <br /> NORTH(N). N _ 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 /> Z <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 9 <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. I Q, <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 1-21 o <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. F <br /> O 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 0 1� <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. `n <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY (h' <br /> PERMITTED. <br /> 4. NOSTRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER 'O <br /> SETBACK AREA. <br /> 5. <br /> X W (fir DOD O -0 <br /> AN n n d N m <br /> 6. m ,c3 nm x ^: = ;a <br /> -o oCDC:00 : � <br /> 7. Z c N m o 1 <br /> O m Tom : <br /> — � ; m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m d fJ <br /> PP ( 9 Y ) Y Y G)C C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m 0 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize i m i C <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- `° v> : <br /> O : <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 o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances other ; ? N <br /> authorized person to have access to the above described pf emises at any reasona e t n. (D 'o <br /> -n <br /> SIGN HERE `^ <br /> nature�qn or building contra r) (da e) i I : 0 ' <br /> OCT 1 5 2004 <br /> ZONING ADMINISTRATOR <br /> 0 <br /> R di EA(A(A(A N <br /> "TOWNSHIP PERMITS MAY BE REQUIREDRURNETT COUNTY <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE QF ISSt f4GTMe ctxka,.- <br /> n7a,t Ltd -fo &✓n r USSccm <br />