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Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator -U o° c <br /> APPLICATION FOR LAND USE PERMITS �. <br /> OWNER �— TELEPHONE 7�S-.115- <br /> S 0, t4r'MCD S.dtiw ` p <br /> X70& ct F C- <br /> MAILING ADDRESS .�j' jy (�1 /'�IVplNtttl�� �✓t$G <br /> PROPERTY ADDRESS <br /> L;?3990 <br /> �l� b6& m <br /> LEGAL DESCRIPTION(see tax receipt) lam� ^ 000(a.24117-01 -7-{{-0®, <br /> DWELLING/BUILDING L7yGARAGE/ACCESSORY STRUCTURE LF ADDITION ❑ - 0 <br /> TYPE OF PERMIT(S): CL <br /> FILLING/GRADING CAMPING UNIT ❑ SUB IVISION ❑ `��,/?t J 6-'0y <br /> STRUCTURE/ADDITION USE: <br /> /} ome/Cabin; mmercial Business; Bedroom; Deck;etc.) ro <br /> BUILDING CONTRACTOR: <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81k X 11 SHEET OF PAPER. ANY INCOMPLETE OR m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) �,.�� pc' j -n o, Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. d I�.d �� m m 70 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)A I ICATE <br /> C c <br /> NORTH <br /> 3. SHOW DIMENSIONSIN 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. 1 ° <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO w <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 2 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. f <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN si ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <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 t <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 9 ymcDi 9Calf <br /> m 3 a m x D <br /> 6. Z yiDoy � o <br /> 7. o T� M <br /> z ni i O <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my ` c '• C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ? Q. �; A <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- <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 ro <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. -n m o <br /> CD <br /> SIGN HERE <br /> -a v <br /> gn re of in or building contractor) (date) a <br /> ZONING ADMINISTRATOR <br /> NOrG (JPO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> C _ THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE VV <br />