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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 /> h0yM& b5i -417-3114 <br /> OWNER / el C1�e e> C ST P�Y15Cr zf TELEPHONE e)1 51- a5 3-13 8g v QJ <br /> MAILINGADDRESS75Q <br /> r m <br /> PROPERTY ADDRESSI �- (`� o <br /> n ,Y`I 0 <br /> LEGAL DESCRIPTION(see tax receipt) �' l S rn Vr I 1 I , /L. <br /> 1 1 L_ `7 y <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION Off`/ <br /> TYPE OF PERMIT(S): M <br /> a rn <br /> FILLING/GRADING D CAMPING UNIT ❑ SUBDIVISION ❑ ',^1 1 <br /> STRUCTURE/ADDITION USE: o �/ 1 <br /> ( omeF� /Cabin; Commercial Business;Bedroom;mak;etc.) Cn Do <br /> v <br /> BUILDING CONTRACTOR: <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'h X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> it N <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) O m <br /> n o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 3 M <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE n o ti <br /> mQ ) <br /> NORTH(N). C T-C-,13 <br /> n <br /> SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDINGS)TO ALL LOT LINES,(B)BUILDINGS)TO mCENTERLIE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OFLAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TOo <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> S. 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. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o o SU <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z ) <br /> CONDITIONS OF PERMIT: P <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. /Y�IFS�In(,;2 ef sp4b �C -C-L, (Ii-Ko/n 0'p//-ttt� <br /> �/ /� A 0r- > 0Dp -0 <br /> 6. l S 'be re'- N —C lu I!- ��G jE'S��� ° m C " $ Cl f m <br /> D �' 3 a � x '. fD � <br /> N C y N O <br /> 7. Z N O O <br /> P it Im <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my — q' ID <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m v, C <br /> all 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 t7 <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 Bring county ordinances or other <br /> authorized person to have a cess to the above described pre3w <br /> r a for the purpose of inspection. m <br /> -n O <br /> (D N <br /> SIGN HEREd, <br /> Sig ature of ow o building contractor) (date) Q o' <br /> ZONING ADMINISTRATORll tJ <br /> fA 69 fA te N <br /> BURNETT COUNTY (33y(-/4- " 1 N N 0 0 <br /> TOWNSHIP PERMITS MAY BNIBED- u 0 <br /> FZ� <br />