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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 /> (i <br /> N 0 O �J <br /> N <br /> OWNER ROGK/)E H. A_,jd JA,. 6 H. cLsoa TELEPHONEGs/ - 63 3 -9C2-0 O <br /> m <br /> MAILINGADDRESS �S•` <br /> � CD0 <br /> PROPERTY ADDRESS Xc, t <br /> N <br /> / o ,J O <br /> LEGAL DESCRIPTION(see tax receipt) C J <br /> DWELLING/BUILDING yC]I, GARAGE/ACCESSORY STRUCTURE ❑ ADDITION q <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ CLS.L <br /> STRUCTURE/ADDITION USE: 1 r X G O l off E [° i r� a o <br /> � <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) rn <br /> / J <br /> d <br /> BUILDING CONTRACTOR: W f}r-1 S r`}' <br /> r <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 17 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m 3 3 <br /> O <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O C. <br /> n CL <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C n <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. C 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. j <br /> C <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, CONTRACTOR, ETC.,THE PLANS ( 0 ) <br /> MUST BE SIGNED AND DATED BY THE OWNER. p <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o, d <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z ( � <br /> CONDITIONS OF PERMIT: ° <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT n ` <br /> ISSUANCE. �j I b <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. p0 C <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY — <br /> PERMITTED. --R) <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER GKJ <br /> SETBACK AREA. <br /> 5. <br /> 6. m °O 00 (00 > m <br /> m 3 CL (D <br /> � n � <br /> C <br /> 7. Z N0 <br /> ^ � � 3 <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �' <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m <n C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize (� CD o : m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- fD <br /> 0: <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection m <br /> CD o : <br /> SIGN HERE`) m m <br /> (signature ow or bui n ntractor) (date) 2 i a <br /> ZONING ADMINISTRATOR 11Z2- 03 G <br /> G <A fA ER fA�N <br /> TOWN IP PERMITS MAY BE REQUIRED �� <br />