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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 /> ; O <br /> H <br /> CD <br /> OWNER TELEPHONE 5( art651-770- C <br /> 0 O <br /> m <br /> MAILING ADDRESS —1111 N_ N o wu t-cI S+. , h Irh N 5 S 1 2 v O <br /> ua CW��Z <br /> II l 1 1 1r� <br /> PROPERTY ADDRESS 6 81( S+i,6 RA, WLb s Tzr w I U) <br /> Lo}s I 3,4 ) 131ocK 1 a4 Tensoh's LaKe- S ori 1 <br /> P 'n <br /> LEGAL DESCRIPTION(see tax receipt) b iyi S ico f Devi�'f I_g K t I3ur nt�F CCoyw �y lJ= C <br /> y I\\S <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION X 1 ��o <br /> TYPE OF PERMIT(S): v'' <br /> FILLING/GRADING ❑ CAMPING UNIT 1:1 SUBDIVISION ❑ 1\ c1 '/ ry, <br /> STRUCTURE/ADDITION USE:�'Se4foM ncYUn �� n CWi Tilt 2swOt/ 5+Ws -6 LgK� � � .S <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;dtc.) rn <br /> (' d <br /> BUILDING CONTRACTOR: se'4- CD <br /> m <br /> v _ <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 /> A y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p o <br /> T o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. z <br /> n Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <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 m <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 <br /> gj <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Np <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS O l0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. = c, o <br /> U3 <br /> vN <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. 0[ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o I_U <br /> CONDITIONS OF PERMIT: <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. k <br /> 6. � k <br /> 0 CL M <br /> 6. 3amOx <br /> O N C y N O 3 <br /> 7. Z � o <br /> o -n' <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my — r^ A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of �i m 0 e, c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CD o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 0 <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 <br /> authorized person to have access to the above described premises at an reasonable time for the purpose of inspection. fD O <br /> CD o : <br /> m m <br /> SIGN HERE 0 `^ <br /> n : <br /> (signature of owner or building contractor) D / ( (date) p � <br /> ZONING ADMINISTRATOR <br /> N U N N N O O <br /> NO (T00 0 <br /> TOWNSHIP PERMITS MAY B COLINTY,;O- oS - el-- <br /> ZONING <br />