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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 O <br /> CDN <br /> C <br /> OWNER + �U �T2� TELEPHONE 7/S -a s9 .303 8 <br /> a�-7 39 r; o <br /> MAILING ADDRESS F <br /> r m <br /> 0 <br /> PROPERTYADDRESS L3Ke Q. <br /> p Lur a c Sry1 \". f j(or (6 -7 <br /> LEGAL DESCRIPTION(see tax receipt) f af+oc' S F Vq 04 A40- s(,u/cf �t q -F40R liW (� � <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ C t/> <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> T. <br /> STRUCTURE/ADDITION USE: E—u¢r&L se5[w"4id'( 0 (� <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) cn <br /> / d <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O 3 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m c <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 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF I 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 (j <br /> BUILDINGS, ROADS, LAKE, LOT LINES. 1 <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 I <br /> MUST BE SIGNED AND DATED BY THE OWNER. 04 <br /> o � <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. l <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z Q <br /> 0 <br /> CONDITIONS OF PERMIT: UQ`, <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT l'l� <br /> ISSUANCE. b <br /> � U� O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 0 <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 /> 6. m 3 nm yam <br /> O M C y N 0 3 <br /> 7. Z N N O O —{ <br /> T Z �t <br /> Cn : M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of u 0 .n <br /> \\ n" : v <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize V m m C3 : mo <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- \: <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 perm <br /> i county officials charged with i in county ordinances or other <br /> authorized person to have access to the a described remises at an spection. m <br /> m o : <br /> m m <br /> SIGN HERE E ` <br /> n : <br /> (signatur&of owner or b ilding contractor) J ,J (date <br /> ZONING ADMINISTRATOR , OCTLr C <br /> BURNETT COUNTY <br /> N (TNN O <br /> t/ (T O (T (T O <br /> TOWNSHIP PERMITS MAY BE REQUIREEEONING <br />