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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 /> N <br /> 0 <br /> N <br /> Jq C <br /> OWNER N '� y,� TELEPHONE �1j"I_�o�. S—tl I I Q O OG) <br /> CD <br /> 0019 A1s-16MAILINGADDRESS <br /> I <br /> PROPERTYADDRESS I0�q � 4yy L <br /> LEGAL DESCRIPTION(see tax receipt) P� $ `7S— Ct) <br /> m <br /> TYPE OF PERMIT(S): <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ d y 0 <br /> it <br /> FILLING/GRADING ❑ CCA7MPIN UNIT 1:1 SUBDIVISION ❑ �' <br /> STRUCTURE/ADDITION USE: n h Ria WQ-bv J.( <br /> \ .b <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) Cn <br /> BUILDING CONTRACTOR: <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. OT N <br /> y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n n <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. (1 A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <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 /> 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 /> 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. _ o <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VE� �I <br /> � o <br /> ONE WHEN <br /> NEEDED. (�� ,y � ' <br /> V �r <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o Q <br /> CONDITIONS OF PERMIT: 01? <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYftpKgIT CUW <br /> ISSUANCE. �����/VV <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHOR � C'�(�/V7y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY "SING <br /> PERMITTED. (� <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER tP�Y�j <br /> S T ACK AREA. // <br /> X mr0vaov <br /> 3 & @ �c c <br /> 6. <br /> O ry C <br /> 7. z N m 0 ' <br /> O <br /> "2 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of w cc) v+ <br /> Q. c : i1 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m 0 : m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- p� <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 I� d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m o <br /> ,( CD m' <br /> SIGN HERE <br /> n : <br /> lure of o or building contractor) date) \: <br /> `�� <br /> ZONING ADMINISTRATOR (/LJ / O <br /> N (T N N O O <br /> TOWN HIP PERMITS MAY BE REQUIRED $ 3 <br />