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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator _U o° o <br /> APPLICATION FOR LAND USE PERMITS 3 = 9j <br /> 5 <br /> N <br /> N <br /> \ 1 ` Z <br /> OWNER (� C (�� I fJ TELEPHONE <br /> MAILINGADDRESS , TIT t K / O <br /> PROPERTY ADDRESS d V I Q ,%�`, i ,"� j-�'� w�I�� 3 1 vM 1 <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION <br /> TYPE OF PERMIT(S): Uj c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ S. <br /> S. <br /> STRUCTURE/ADDITION USE: b(j S I n P 9 X 2 o <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) d <br /> BUILDING CONTRACTOR: 'ChMYYISu dl�u S t J <br /> d <br /> CD <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 71 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> M O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> n <br /> ?I Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C T nR <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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <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. N O <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTR onLANs ,� O6 2. AJ <br /> MUST BE SIGNED AND DATED BY THE OWNER. f ^J� a <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICAII N MAY BE DONE W N <br /> NEEDED. n <br /> Ea t, 2003 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o 'Y <br /> CONDITIONS OF PERMIT: SURNE7-r C <br /> pr",1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ZONINOVNTy Jpp�� <br /> ISSUANCE. N <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 06 t <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY �C <br /> PERMITTED. C� <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER C!j <br /> SETBACK AREA. <br /> 5. <br /> m <br /> 6. $ 3amOx <br /> (�D <br /> Z N O O <br /> 7. O <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of myG3C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d n cn <br /> a^ : : Fn- <br /> that <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize <br /> aO <br /> that this information 1 am providing will be relied upon by the County ftf Burnett Wisconsin in determining whether to is- <br /> sue apermit. I further accept all liability which may be a Ito th unty of Burnett relying on this information I am m <br /> providing in this application. I agree to permit ounty o Ici Is ar a with administering county ordinances or other <br /> Cn <br /> authorized person to have access to the above escribed pr is s at any easonable time for the purpose of Inspection. o ; <br /> n m m <br /> SIGN HERE n <br /> (signatu of owner or b Ing con ctor) (date) <br /> ZONING ADMINISTRATOR cn En <br /> fA EA EA fA-+ N I l� <br /> N N N O O V <br /> � V10 0 Vt (TOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />