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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 . <br /> r <br /> m O <br /> N <br /> c <br /> OWNER �V tori Le 4.�5 C9r, TELEPHONE -S= 0te7 d . <br /> A <br /> MAILING ADDRESS 3 Le S`s`b <br /> r m <br /> 0 <br /> PROPERTYADDRESS �$ N�� �L <br /> LlLEGAL DESCRIPTION(see tax receipt) + ( - -/Q-% ( m <br /> c <br /> TYPE OF PERMIT(S): <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ ^ <br /> VI(/ Q � <br /> FILLING/GRADING ❑ CAMPING UNIT 1:1 SUBDIVISION ElS. T <br /> C N �• <br /> STRUCTURE/ADDITION USE: ��X S�� S. <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) m <br /> m <br /> BUILDING CONTRACTOR: _ <br /> U <br /> M <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 - <br /> .'tl m (t <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 0 �J <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). W 3� <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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <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. Q <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I 0 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CON,TCTOR, ETC., THE PLANS > <br /> MUST BE SIGNED AND DATED BY THE OWNER. L1_l <br /> am` ,$ 0 <br /> �( LZ f` c o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION�NAjN W <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. NO , o <br /> CONDITIONS OF PERMIT: BU1311VF . 24P / <br /> t <br /> ISSUANCE.MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMITZON pUN7-y [I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY (� ` <br /> PERMITTED. Vnv�J �J <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACKAREA <br /> KLA IIJd1�N /a ' �CIYyIl�s%! /L' CD d d 0 my a m <br /> 6. n m/ / V <br /> r O"� '� —td CPI f? w L'O C� �WGLVY� �/J� L2�2ei 3 n <br /> -o � Cy "' ii � 3 <br /> Z in m o `o <br /> 7. o TQ <br /> m <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 o A <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognizem o mo <br /> CD <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 1 <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 have access to the above described premises at any reasonable time for the purpose of inspection. -n m o <br /> m 0 <br /> SIGN HERE <br /> D' �a <br /> (si tut of owner or b n to date <br /> ZONING ADMINISTRATOR G <br /> — pj <br /> e» <br /> `wN•� N (T N NOO <br /> UtO (T (TOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />