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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 /> - r <br /> N � <br /> N <br /> C <br /> OWNER gFlym/"/ r DoT;0^/�� TELEPHONE /(,3-7,5 -0 7ffq o. <br /> v <br /> `� /p �j d <br /> MAILING ADDRESS /a lI C 8 FdJZf ka J 1 UC(', d6l �,4� clf N)!I( Srq 4CD <br /> 0 O <br /> PROPERTY ADDRESS (fPO/yT � 4hE ed Wf-�TF2 <br /> LEGAL DESCRIPTION(see tax receipt) ��y� �,eiSw i4CrzsS 4'�0 0 <br /> canit�J/1 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ® ADDITION rn 0 <br /> TYPE OF PERMIT(S): ) v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ C> <br /> STRUCTURE/ADDITION USE: /4Al0L1/s^fdk.y e 2C <br /> MLIU alai J0 UP 50 <br /> ome/Cabin;Commercial Business; Bedroom; Deck;e&.) d <br /> BUILDING CONTRACTOR: <br /> iu <br /> Z � <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/a X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O O <br /> y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o C <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). N O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO to 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. 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 GRADE LED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,J PLANS V 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 <br /> � o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFI ATION MAY BED N "� ° Q <br /> kHE <br /> NEEDED. % <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. OR R G rj o I <br /> DITIONS OF PERMIT: <br /> ONDRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Z N N CV N�' <br /> ISSUANCE. G <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. (N <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 d <br /> SETBACK AREA. <br /> 5. �L�o /�- C <br /> � �d�onov <br /> 6. �lJC1�vl,l.1 Y CJ 7 1• — QS ��� �l � �\'� 3 n m x n <br /> 'O N C <br /> 7. Z Vl NO <br /> O T K 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 1 am responsible for the detail and accuracy of �l m c v+ <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o m <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized rson to have access tq the above described premises at any reasonable time for the purpose of inspection. 'D <br /> o : <br /> M m : <br /> SIGN HEREy//'90 3 "' <br /> a : <br /> (signatu a of o er or building contractor) (date) <br /> ZONING ADMINISTRATOR �-//I1� 0 <br /> N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED ° 0 0 <br />