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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 /> r <br /> y O <br /> r y ` <br /> /�///j i L//' C W <br /> OWNER ��Z / /l �Q/ /itl EPHONE ��/� "74? Z. <br /> m <br /> O <br /> MAILINGADDRESSf <br /> �c� r <br /> ° <br /> PROPERTYADDRESS ieLtL i✓CjAbto� G�� ,3�� �PpFo( <br /> H <br /> LEGAL DESCRIPTION(see tax receipt)t.a9tt 1 0 6UtIc <br /> T `I JZ46 �//Y J`�r./ � �vr <br /> 1 <br /> DWELLING/BUILDING X GARAGE/ACCESSORY STR�URE ❑ ADDITION ❑ �' <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADDIING/�❑ CAMPING UNIT 1:1 SUBDIVISION <br /> ° <br /> ❑ <br /> STRUCTURE/ADDITION USE: � s 1" <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) Cl) .,., <br /> BUILDING CONTRACTOR: <br /> m � <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. p -- <br /> DIRECTIONS <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> -n O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE jg <br /> NORTH(N). ((n o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m3 <br /> Ga <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF ` Z <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 <br /> BUILDINGS, ROADS, LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Q N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS (� ° <br /> 3 . -4 P <br /> MUST BE SIGNED AND DATED BY THE OWNER. ° t <br /> o n <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> 0 <br /> CONDITIONS OF PERMIT: r U t <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT t . O <br /> ISSUANCE. 'P <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. LA <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ! Q) <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> CD C° vd � � a : m <br /> 6. CD x3 yam xa <br /> omc �, `� iS � � <br /> 7. o <br /> - rn : m <br /> I declare that this application (including an accompanying schedule has been examined b me and to the best of m d L7 <br /> (� 9 Y 9 ) Y Y <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of J d n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- s <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. 1 agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. a <br /> r <br /> m D <br /> CD a : <br /> SIGN HERE 71W/ (n a ' <br /> (ign�are of owner b ilding contractor) (date) 0 <br /> ZONING ADMINISTRATORd `• <br /> v 469EA ffl EA fA461N <br /> (1 ONOCn Cn CnO <br /> TOWNSHIP PERMITS MAY BE REQUIRED/ }���j l�J[/� C� n <br /> THI a r d-��ITW (�yi�IF�a D-to tj 0 `17 11Q� -&,1&lS /' /9 �V� <br />