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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 71 o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> y O <br /> N <br /> C <br /> OWNER l�,hC��` e ( ( �,C1� �� TELEPHONE <br /> MAILING ADDRESS <br /> PROPERTYADDRESS �aad8 af-c6-tea rG� <br /> LEGAL DESCRIPTION(see tax receipt) c'"— <br /> SC' -AiOn l (lSlJn 1 �Lcr�ye ��Sw Ll� CSrn(/ ill m <br /> DWELLING/BUILDING WGARAGE/ACCESSORY STRUCTURE 1:1ADDITION ❑ �' W O <br /> TYPE OF PERMIT(S): C*3 Lel artlf> it <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ O' <br /> STRUCTURE/ADDITION USE: q O m't° 0 �" <br /> (� <br /> (Home/Cabin; Commercial <br /> Business; Bedroom; Deck; etc.) W <br /> BUILDING CONTRACTOR: 1�.�a � I.i.l ��j�l / (,)1.1da h <br /> -4 <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 /> T7 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. A m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m `? _ <br /> NORTH(N). y o <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. , 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. 1 <br /> S. 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 <br /> o � I <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN » <br /> NEEDED. � �\ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Zo ) <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 WATER <br /> SETBACK AREA. <br /> 5. <br /> M m6. C W M n M n :O m <br /> O o o n o o m <br /> a m C O <br /> Z c to N o O <br /> 7. O In <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best'o' <br /> m <br /> — m D <br /> PP ( 9 Y ) Y Y ` Qc � : C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of 1 'm - : r" <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- `� m <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 v o <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. <br /> T <br /> Di <br /> SIGNHERE <br /> (s' na re of ow r building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> v+cn ea E» <br /> O N Uf W W N <br /> O (TO (T USN <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> �e,+rmr� � �et�t'��rt£-f� Can9henry's 5-�0� <br />