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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> OWNER f},e/2 (1( TELEPHONE Hoc �'I-H�}'L-Fj7'L TELEPHONE & S/ — /3 (O / Fr V a <br /> p .\ <br /> MAILINGADDRESS /uO, 9 O/Sr-"i«,Na-rn���, mom. ssos <br /> PROPERTY ADDRESS p� S��,S - �d thySON K6 /cp' , <br /> LEGAL DESCRIPTION(see tax receipt) ��)l eT-L-r- ) <br /> m <br /> R <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE L ADDITION C <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ElCAMPING UNIT ❑ z <br /> SUBDIVISION ❑ n <br /> I 5 <br /> STRUCTURE/ADDITION USE: yX Iy o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) ( r ,` <br /> BUILDING CONTRACTOR: <br /> � fO <br /> v � <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/X 11 SHEET OF PAPER. ANY INCOMPLETE OR TO 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING- (AERIAL OR TOP VIEW) O m 1 <br /> -n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m �? <br /> NORTH(N). <br /> n <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. '� o <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 /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. IN <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0 o <br /> MUST BE SIGNED AND DATED BY THE OWNER. 1 <br /> p 0 <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN 0 -� <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. O 1} <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 93 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> A In 0r- D0 Dp -0 <br /> m c m d 0 0 a 'e M <br /> 6. x 3 a m x- <br /> p N C y y 0 = �+ <br /> 7. Z N O J ,O <br /> 0 N : T•G : m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m <br /> PP , 9 Y ) Y Y C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of iu n : u, <br /> PP (including Yaccompanying ) 9 'Q` <br /> all information contained In this application Includin an schedule and I further declare that I reco cognize E m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- i i i <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnettrelying on this information I am m ' 0 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ` ,o <br /> authorized person to ave access to the fyve described premises at any reasonable time for the purpose of inspection. m <br /> Tt n <br /> D <br /> SIGN HER <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR J(m FIG.n(clah : <br /> O fA fA fA bi 69�N <br /> TOWNSHIP PERMITS MAY BE REQUIRED C o a o w w N o <br /> HIS PE MIT SHA XPIRE ONE E FRO DATE OF S ANCE <br /> Le4o <br /> I -F <br />