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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -00 Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> M y O '^ <br /> OWNER 1)Q Le t7"^I �1Q C'�,_Vl/�( f� /r\• TELEPHONE 7/S— 74,( — 1 vZ 0 p Y <br /> MAILING ADDRESS P I' Q`h -7 � e LL Lc (�, t c��- Y� 7 <br /> ,�Y o <br /> PROPERTYADDRESS CtC M ? L <br /> a <br /> LEGAL DESCRIPTION(see tax receipt) W) d <br /> 5 �L3sT3 � NIIwic `i / <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ 'ADDITION ❑ y <br /> 0 <br /> TYPE OF PERMIT(S): c (kms <br /> FILLING/GRADING ❑ CAMPING UNIT Law <br /> SUBDIVISION ❑ <br /> `~ J <br /> S. <br /> STRUCTURE/ADDITION USE: ('Y)^I 1 "' 0 tu� 3 I — e2 cpL _� 0 f `t <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) y - 1 <br /> m <br /> BUILDING CONTRACTOR: <br /> U <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m0 3 <br /> 1tl N 1 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n 0 d <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m CD <br /> NORTH(N). <br /> C1 <br /> 9 <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. 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 GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS 0 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> o 0 ' <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VTIo HEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. M ' o <br /> CONDITIONS OF PERMIT: �I 9 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS <br /> ISSUANCE. 7Q1 r C`,0� 7-�� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHOR�t �NG Nr <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 /> 6. � m mm >'0'OQOV <br /> CD 3 n M a m y <br /> v' mCy !" o � 3 <br /> 7. O <br /> o T <br /> declare that this application (including any accompanying schedule) has been examined by me and to the best of my -r^ A <br /> � c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d n Er+ C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m c o 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. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized pqrj'o-n'tp have access to the above described premises at any reasonable time for the purpose of inspection. m ? <br /> m o : <br /> m m <br /> SIGN HERE D3 d' <br /> Q <br /> (signature of owner or 'ding contractor (date) Q ) <br /> r <br /> ZONING ADMINISTRATOR <br /> Q N 0 N N O O <br /> (T Otn (POO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />