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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 71 o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> _ r <br /> CDN � <br /> N <br /> C <br /> OWNER TELEPHONE <br /> 1) 6-5-t <br /> MAILING ADDRESS £O <br /> JC �c� CiLli' ; fr- glar;x� O7�r Sf �'Yo,X i►f1 <br /> l r m <br /> Cr O <br /> La <br /> PROPERTYADDRESS -( 6'6 <br /> LEGAL DESCRIPTION(see tax receipt) LO 1 S I I - 40—16 � m <br /> �p <br /> DWELLING/BUILDING 1:1GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ Y ° <br /> TYPE OF PERMIT(S): c� n <br /> FILLING/GPADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 1 � <br /> STRUCTURE/ADDITION USE: r h1 C a 6. -to by Mo d e 4 C-)t. JCo = <br /> (Home/Cabin; Commercial Business;Bedroom; Deck;etc.) C <br /> BUILDING CONTRACTOR: C Lt) L'te5CD <br /> d <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. m <br /> M y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O 2 <br /> nZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 � X <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m� <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 Z <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. P <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. Co <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN " ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <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. <br /> 5. <br /> M W 0 M a * m <br /> 6. 9 nMO Oam ,"0 <br /> N ut O = 3 <br /> O T G <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G�c ID <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of iu <br /> CLte : v, : ;aall information contained in this application(including any accompanying schedule)and I further declare that I 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- CD <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 d <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 any reasonable time for the purpose of inspection. m o <br /> m (D <br /> / m <br /> SIGN HERE h..I.---ta 'Z- n <br /> (signature <br /> f owner or building contractor) (d tel <br /> ZONING ADMINISTRATORy ) <br /> fA EA EA 64 N <br /> N Ot N N O <br /> in O N (T O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 9 <br />