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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 /> rn O <br /> Vi <br /> CD <br /> r /-n �` C <br /> OWNER \T _`� may` TELEPHONE <br /> JJ I - ' 1 m <br /> MAILING ADDRESS460 FAC _m S���/ r <br /> PROPERTY ADDRESS <br /> S Z ILL r ' ° <br /> cwt S wT' -4 eS M v Q P a -t Z ' '�- <br /> LEGAL DESCRIPTION(see tax receipt) �•�— 5' e-- Lj �� � ZE� Iy 5(v �Jr� En <br /> - <br /> 9 m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ t Q� (� <br /> TYPE OF PERMIT(S): d r Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> 11NK-- 1s� N <br /> STRUCTURE/ADDITION USE: pi �0 <br /> (Home/Cabin; Commercial Business;Bedroom;Deck;etc.) d <br /> CA <br /> BUILDING CONTRACTOR: -'r L (JCw)Nl/> — ILk. <br /> iv <br /> Z <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 61/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> XI N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O CCD <br /> T Z <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 <br /> NORTH(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 <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. ,3o J <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CO(J FACTOR, ETC., THE PLANS �0� 10 Q <br /> MUST BE SIGNED AND DATED BY THE OWNER. ✓/ ,.'. -� u W <br /> `�� v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFI ATION WHEN ° <br /> NEEDED.THIS PERMIT IS <br /> ( 1 <br /> CONDITIONS OF PERM TT TO ALL CONDITIONS LISTED BELOW. e� ✓��� o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERkno,�,T2. EMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELIN�.P�/`/^^OZjy` <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY �7 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. /f <br /> 5.S.#jL TwI <br /> m m lid <br /> rco � n0 <br /> d <br /> 6. � $ 3 n � n � � <br /> C N <br /> �c lia r� <br /> ` m <br /> 7. Z n co o ' 1 <br /> o nom : M <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) A <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of @ v, <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize (D 0 0 <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to hav access to the above described premises at any reasonable time for the purpose of inspection. m <br /> m o : <br /> CD <br /> SIGN HERE <br /> � . <br /> i Lure of own&r or building contra ate) <br /> c€ i <br /> ZONING ADMINISTRAT QIV If! <br /> (�N C N O <br /> O (T O <br /> TOWNSHIP PERMI MAY BE REQUIRED <br />