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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 /> N <br /> OWNER <br /> TELEPHONE (o3,cwe ,,A GrenK -ac( <br /> MAILINGADDRESS Old 35 (reAj (J(S <br /> d <br /> 5'Ma <br /> r � <br /> PROPERTY ADDRESS S(R?9 O 01j 3:5 <br /> 0 <br /> I -rvya swsw�x p.- � <br /> LEGAL DESCRIPTION(see tax receipt) Pe- 1 '<'e' Qq I T3 gN. R I LJCD <br /> { <br /> Ei <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE LItJ ADDITION ❑ U) o r' <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING ❑ <br /> c CAMPIN/G Ur 1 ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITIONUSE: S+araelO <br /> O <br /> (Home/ abin;Com rcial Business;Bedroom; Deck;etc.) C Z <br /> Im <br /> BUILDING CONTRACTOR: /\ <br /> m <br /> IJ <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 �f0 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n N OD Z <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. A m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m S— <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. o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO Q�> <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, C CTOR, ETC., THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o .— <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VER CAT HEN o <br /> NEEDED. ✓ ���//// �)//� � � J <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. u'� o <br /> CONDITIONS OF PERMIT: 9ft <br /> Y <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PER <br /> O COU <br /> ISSUANCE. ,t, O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE.•�^/(� 'YTy t^, <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> X W 0 ( n � m <br /> 6. 3a (OD xft ;u <br /> 7. Z in0o <br /> o (D <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my G)c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d c, : d, <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CD c o m <br /> that this information I am providing will be relied upon b the County of Burnett Wisconsin in determining whether to is- (D <br /> P 9 P Y tY 9 � � <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 d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpo a of inspection. ° o <br /> / Q <br /> IT m <br /> SIGN HERE 11J ' ( d' 'n <br /> (sign r of owne"rquilding contractor) (date) <br /> ZONING ADMINISTRATOR <br /> VT---TQ <br /> -HIP PERMITS MAY BE REQUIRED N 0 0 <br />