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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 /> N O^ <br /> N <br /> CL <br /> C <br /> l <br /> OWNER f ajLC� QaeTELEPHOI _3 — I o� o <br /> _� <br /> MAILINGADDRESS Z.Q <br /> 0 <br /> PROPERTY ADDRESS b 5-U 1—�js--)w4 P 4e3� <br /> (� 1 <br /> LEGAL DESCRIPTION(see tax receipt) LoV 2C) / `�n�fv aA \�/P ✓ ey/ l n �� n <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ o` <br /> TYPE OF PERMIT(S): FL <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> \ N <br /> STRUCTURE/ADDITION USE: �7 �£7 " Q�` O kA 0 (p <br /> � P <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: <br /> r <br /> N <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> M m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n <br /> m <br /> T oj Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> C o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> v <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. ° <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. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. O I <br /> v � � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VER7,T{QMIk!A � WHEN o <br /> NEEDED. /(��L =�U <br /> r V 7 J Ji SISI 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: APR 2 d <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS @E PERMIT 7 <br /> ISSUANCE. �� �❑p� I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG St NETT COUNTY (1 J <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ZONING r� q <br /> PERMITTED. V <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA, / <br /> s. &r -�-p I' S S11,^U� lG\l� d' >0> 0 <br /> 6. lQncb 1l l� G 3 nm 0xR � <br /> V (D C ,Nj, <br /> 2 N O <br /> 7. O n Zt <br /> IM <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a 0 N <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m O my <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 o0 <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 purpose of inspection. o <br /> CD <br /> M <br /> SIGN HERE 4� n <br /> (signature of owndr or bu dipg contractorl (date) <br /> ZONING ADMINISTRATOR a<z�. 69n <br /> fA fA fA N <br /> N U 0 t N N 0 O O <br /> (TON(r00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />