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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 /> 0 <br /> OWNER '✓ 7r ! L TELEPHONE 3,..5 2�l V <br /> m <br /> V <br /> � O <br /> MAILING ADDRESS 3D 7b R 0.4cl T <br /> o ,p /^/ �j C� �j r <br /> PROPERTY ADDRESS Y P .e Al S � k �'✓ ( k� ° <br /> �j�� <br /> LEGAL DESCRIPTION(see tax receipt) p-f mom u_ o i 3,p% <br /> DWELLING/BUILDING <br /> ❑ GARAGE/ACCESSORY STRUCTURE [-1ADDITION ❑ c D <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT 1:1SUBDIVISION El �j a <br /> STRUCTURE/ADDITION USE: O n �- cS lo`I 00 u J <br /> oQWBp'� (Home Cabin; Commercial Business; Bedroom; Deck; tc.) c <br /> BUILDING CONTRACTOR: --� — -3..5'f X .211 ( 7b 59 0"'T) v �, <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/.X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. N��_ Qt^lot,K S tri Q A N W } <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP SchkIActc <br /> �_ } <br /> G`� M o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. (11 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). "t <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDINGm S)TO _,r, D <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. P <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO O <br /> BUILDINGS, ROADS, LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. O N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0_ o0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. ° <br /> O � _ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN FA ° <br /> NEEDED. ° 1 <br /> I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o C O <br /> CONDITIONS OF PERMIT: W <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT J CNI <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. R� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY J <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. Propcv&y MJst P&4A-nv rni 50Wuaj0 Pwr&,Tia.J P/bq A co 0 r a 0 D 0 v <br /> CD c m m ° m n £ m <br /> m x3 =arn �- nm <br /> 6. O C y y j 3 <br /> Z C V N O <br /> 7. N -n q m <br /> . m : En: A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of r! \\ n <br /> W <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ° m C <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- i o <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am — ° <br /> providing in this appl' tion. I agree to permit county officials charged with administering county ordinances or other �— <br /> authorized person ve access te abo a desc ' ed premises at any reasonable time for the purpose of inspection. T m a <br /> / D : <br /> SIGN HERE a <br /> ig u er or bui ontractor) (dat ) [ <br /> 6 <br /> ZONING ADMINISTRATOR f <br /> SEA 69 fA Efl�N <br /> TO SHIP PE ITS MAY BE REQUIRED <br /> THIS PERMIT SHA EXPIR ONE YEAR F DATE` iska�sKuS-J�- <br />