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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator '0 o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> to O <br /> y <br /> C <br /> N <br /> d <br /> OWNER �Ob P TELEPHONE ^p )y <br /> MAILINGADDRESS m <br /> 1��7a3 F�ncLay /� yen��DD�� fM7U ���a ° <br /> PROPERTYADDRESS '7305 FrcmSfed <br /> ,5 - r',0 m <br /> LEGAL DESCRIPTION(see tax receipt) Oak l and �Sho res 1-0-/- q 8(Kl ,p, /& c CD <br /> CD <br /> DWELLING/BUILDING 1:1GARAGE/ACCESSORY STRUCTURE ElADDITION.V ° <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ N. ' ' <br /> STRUCTURE/ADDITIONUSE: I.)Jc C;O ScreQn fl ' j% 1-2 )tl-) <br /> 1 (Home/Cabin; Commercial Business;Bedroom; Deck;etc.) d <br /> BUILDING CONTRACTOR: &146i s ca,2ry.� P6 4 ` 5t?4 <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR .n 3 l ^ <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. � <br /> N O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) a 1 <br /> T v z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 9 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE M n <br /> NORTH(N). 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 l+ <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS ^� <br /> MUST BE SIGNED AND DATED BY THE OWNER. ��� f I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFIq/I/T�t'�YYIAY BE DONE WHEN <br /> o <br /> NEEDED. ° <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o t <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS 6"4RMII' J �� <br /> ISSUANCE. //��//��.. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHO <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICAL Y11 <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED'VATA � <br /> SETBACK AREA. <br /> 5. '1Q_Qa — jDb' i pr-zg-p <br /> �� ✓�i uG-CA l m wr o m Da O V <br /> 0. <br /> m <br /> is 3 nm �°c °:m � <br /> 6. <br /> CD <br /> O <br /> 7. o T� ' m <br /> = cn; A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my cj <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of a N <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o <br /> that this information 1 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 N <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m o <br /> 9—i�— C <br /> SIGN HERE c' a <br /> ( g lure of own o wilding contrac ► (date) <br /> d <br /> ZONING ADMINISTRATOR d' 169 <br /> EA fA M 1.9N <br /> QNCT P0 <br /> CT OCT TOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED (V� <br />