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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 /> X43- 95--) - s 3— rLI <br /> OWNER--.,')I An 4D r N TELEPHONE �' C) <br /> MAILINGADDRESS •r ..�.-�®�!i �� \ __ '7''I -I�V /ZVC rV'l�, `�"r"`- .� r <br /> m rJ 530 ( <br /> PROPERTY ADDRESS j0 O`� <br /> / r <br /> LEGAL DESCRIPTION(see tax receipt) r �v • � 1� I�'� <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ® 1(n <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION S. <br /> STRUCTURE/ADDITION USE: `�, Cc>n n. t'1r ���p �n. � � 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) rn <br /> d <br /> BUILDING CONTRACTOR: <br /> -o <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O _ <br /> w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> n <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <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 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. t o <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO Car <br /> BUILDINGS, ROADS, LAKE, LOT LINES. I <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N R <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 0 Xll <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 r <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHENo <br /> NEEDED. ou (j, <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o ) <br /> CONDITIONS OF PERMIT: a <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT fY� <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 N�f.1 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> m C M 0 onom <br /> 6. m x3 nm yam .� <br /> Z c y o -� <br /> I declare that this application (including an accompanying schedule has been examined b me and to the best of m - o En: O <br /> ( 9 Y Y 9 ) Y Y G) C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o e <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize m m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- `D U) <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 o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other n 0 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. ° n <br /> m <br /> ` m > : <br /> SIGN HERE ' <br /> (signature of owiW or building contractor) (date) o <br /> ZONING ADMINISTRATOR <br /> O N N W W N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N <br /> THIS EERMIT SkiLL ,x PI �nONE YEAR ROM DAT OF ISANCE <br /> fYl1 d Er <br /> CT <br /> (Yl. '. (0 � QnS t-lCf7on �o lQ'QS <br />