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Burnett County 7410 Co. Rd. K, No. 102,.Siren,WI 54872 Office of Zoning Administrator Tc, z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> 6T 0 <br /> OWNER t D �am 1 1 1 an y� n .� TELEPHONE CP�J I 4(,p-3 _ 1 V1 L4 <br /> MAIUNGADDRESS l I �I m �V�l/ ,"`t if c�+n MIN 5 5 0 9L L4 W <br /> PROPERTY ADDRESS a, 13 Q r)3 aM t r� iD oi-n b-,Lr%� W1 5 4 ' 3 O <br /> LEGAL DESCRIPTION(see tax receipt) l,vt 1 C5 m N D. 3-1 b1 r V V L I t °t (a a o� 5 <br /> t 3 <br /> TYPE OF PERMIT(S): <br /> r��77 <br /> DWELLING/BUILDING I/VI GARAGE/ACCESSORY STRUCTURE Ll ADDITION [:1o <br /> (1 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ �- i <br /> 5 <br /> N <br /> STRUCTURE/ADDITION USE: OCYV.e y $ o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) (n <br /> BUILDING CONTRACTOR: <br /> m <br /> ' S� <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n _. <br /> OT <br /> ry (y/1 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> a <br /> T <br /> o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m � '1 <br /> NORTH(N). c Q n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m �0 <br /> CENTERLINE OF ROAD,(C)BUILDING(S) MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. z3 0 <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. J N KJ <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS I 2. <br /> MUST BE SIGNED AND DATED BY THE OWNER. Q bo y <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 <br /> 0 o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z 1 <br /> CONDITIONS OF PERMIT: ° <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT * 1 <br /> ISSUANCE. J .� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. O <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 /> s. :5-re64 -tu be j -Wf � v! wu �cc/ <br /> _ * <br /> Wxm n6. OaC � r5J � m/ m 0 <br /> 7. Z c m 0 ID o N 3 <br /> P m � mp <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my — i, :J: 17 E : C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- `D : v 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 iU : o <br /> providing in this application. 1 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 reasons I e 'on. � CD � <br /> SIGN HERE ( � ° D <br /> a : <br /> (Si nature 1 /ure of o er or building contractor) (date) j o' <br /> ZONING ADMINISTRATOR—MI) l ) e <br /> qan <br /> O N P W W N O <br /> TOWNSHIP PERMITS MAY BE REQUIREoBURNETT COUNT' <br /> THIS PERMIT SHALk EXPIR O E EAR FROM DATE OF ISS BIG C <br /> mailed wti �� -k�-t�) ml � 'wa9wI s-�� os- <br />