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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 /> N O <br /> 41 Q <br /> OWNER �r l 1 �- P•1 TELEPHONE 2 4,, �I— L+ p <br /> 97 <br /> MAILING ADDRESS &11-e✓� �j �( y�n <br /> PROPERTY ADDRESS Frem, e Awl <br /> 1 td <br /> -fD <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING K GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ co <br /> TYPE OF PERMIT(S): cr <br /> FILLING/GRADING ❑ CAMPING UNIT L1 SUBDIVISION Eln r1 <br /> < Lt1vJ <br /> STRUCTURE/ADDITION USE: ° <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) U) <br /> m <br /> BUILDING CONTRACTOR: ttiG�� -R� <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O y <br /> Ul <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> M Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 0 m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(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. i P <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. U <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I I <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS I C <br /> MUST BE SIGNED AND DATED BY THE OWNER. f <br /> O � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. rv,} <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> 0 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. ` b <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. \ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY r\\/ O <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> m O r D O D O <br /> 0 f m <br /> n n a p <br /> 6. m F3 CL CD <br /> Z c y o o <br /> �. o o : Tom . m <br /> — v ` in A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C) c C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize mC, mo <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 oO o <br /> providing in this application. I agree to permit county officials charged with adZOO== <br /> i er <br /> authorized person to have access to the above describe premises at any reaso e o o f -n a <br /> in <br /> m . <br /> � D : <br /> SIGN HERE <br /> ignature of owner or building contractor) ( o <br /> MA 1y ' ' i i i E E i <br /> ZONING ADMINISTRATOR d <br /> en Es, <br /> BURNETT COUNTYOO (11n W W <br /> W f N <br /> NNO <br /> TOWNSHIP PERMITS MAY BE REQUIREDZONING C111 O n o n cn n o <br /> THIS PERMIT SHS EXPIRE 4—ONE YEA 7- 4e D P)i C��S,,J[`[CP <br /> > ian dI6 <br />