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Burnett County 7410 Co.Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator 'U 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N � <br /> (/1 <br /> C <br /> OWNERS kr RV3 R C9 K <br /> v <br /> d <br /> MAILING ADDRESSCD <br /> O g(J �D KG K 0 Gc 1b F <br /> PROPERTY ADDRESS <br /> 2�9 Eo Ros �>��� <br /> LEGAL DESCRIPTION(see tax receipt) /4-6 <br /> DWELLING/BUILDING 4 GARAGE/ACCESSORY STRUCTURE ❑ ADDITION (n <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADI G ❑ CAMPING UNIT SUB IVISION ❑ a <br /> STRUCTURE/ADDITIONUSE: �0 C(J 0 0 <br /> Q (Home/Cabin;Co Cercial Business;Bedroom; beck;etc. (� <br /> BUILDING CONTRACTOR: /T Me 1 1 I C�N ()o NS 14ay Id A R Q /• d' <br /> v <br /> CD <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 /> O <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n a <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE nn <br /> NORTH(N). <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO mo <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 - <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 1 N Nom' <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC., THE PLANS �j 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> f <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 <br /> NEEDED. ,10� 7lJ <br /> t�Q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 2o t <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <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 /> 6. /�/ m mm0MaEm <br /> 3 aN x �: � 7i1 <br /> 7. Z ym0rn <br /> C T� rn <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my f 1 , — y ID <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of 11�� G v� C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize W: m o <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. I further accept all liability which may be a result of the County of Burnett relying on this information I am n <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 t4 abovedeffribed premises at any reasonable time for the purpose of inspection. ° o <br /> m m <br /> SIGN HERE / d "' <br /> a <br /> (signet of owne r b t ( te) <br /> ZONING ADMINISTRATOR ®� <br /> e»F» <br /> EA 69 fA fA o N <br /> N N O O <br /> NO (T M 0 0 <br /> TOWN IP PERMITS MAY BE REQUIRED —b <br />