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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 /> y <br /> OWNER C..T-1 G ; Yi Y\Cl e-\ V t\ G o , `A G C- TELEPHONE '-� S - a 5`� <br /> d <br /> (� <br /> MAILING ADDRESS 36 01 G C-00.-� V c_r \^-��'C �V )Ink U O c Y\ U r l\ W <br /> PROPERTYADDRESS S R M E IN 5 M) 6 V i= <br /> LEGAL DESCRIPTION(see tax receipt) L C� 6 eu t- A c�v. o \/ •V , C <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: C 0 <br /> r o c <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) d <br /> BUILDING CONTRACTOR: S ij f vs-44K: U C C)Y\ m <br /> v <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. p -- <br /> DIRECTIONS <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> M o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). (a �� <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m <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. 1 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. J �� <br /> a <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I oC <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS �. o �^ <br /> MUST BE SIGNED AND DATED BY THE OWNER. '° <J <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o I l <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ) <br /> ISSUANCE. <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 WATER5. / <br /> SETBACK A�A. c� / / �64 <br /> Y m d ro Ma � m <br /> 6. m 3 a m n m A <br /> -Q D C N N o = 3 <br /> 7. Z H m o 1 <br /> o '2 <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G7 c C <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of 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 G <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 des ribed prenjises at any reasonable time for the purpose of inspection. o <br /> CD m' <br /> >s l o.e �' d <br /> SIGN HERE �L-�/ - 3/ [ a E <br /> (signature of owner 'r)(Uildia r) (da)b) <br /> ZONING ADMINISTRATOR Z� ^� <br /> (A(A(A(A N <br /> 7+, N(TTNN OO O <br /> O (T (TO <br /> TOWN IP PERMITS MAY BE REQUIRED o23a4P 3 <br />