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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator v G) Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> _ r <br /> N O <br /> N <br /> C <br /> OWNER M p'f sin a1\ 2S- J U• \� 1V \ 1 TELEPHONE �' _ La5 to -3 1© Q o <br /> MAILING ADDRESS � to <br /> CD <br /> / ` F <br /> PROPERTYADDRESS I b IA MQ 1Y\ S ` • OQ��U W +L ( ^ <br /> LEGAL DESCRIPTION(see tax receipt) I19 <br /> ' rn <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE Xr ADDITION ❑ rn ° <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITIONOSE: <br /> l.u YYl b Q f 5V,Q-A t- 4z- r <br /> (Home/Cabin, Commercial Business; Bedroom; Deck,etc.) m Q <br /> o� <br /> BUILDING CONTRACTOR: 'S 5 <br /> m � <br /> (D \ <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. m - <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 3 m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). 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 /> 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 d(:�!) <br /> BUILDINGS, ROADS, LAKE, LOT LINES. � * (I w <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N SU qj <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS 0 ) <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> v 0 . <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 � <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z O C) <br /> CONDITIONS OF PERMIT: P <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. �p <br /> 5. C•, . �_de^..((1_ to <br /> e�ISY(C�ki c�(� ' 'YPr x/ . CD <br /> s. mol d �rafP l/ / Cc3LL5� l IS 3 a 0 a <br /> 7. does. �� ✓nem - s) /Ot 1(nN o :� � ac i�. Z " (D 1n = ' 3 <br /> y O p <br /> 4 T� x <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my - r^ A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m n <» C <br /> CL cn : <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CD O mo <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 w <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. CD o <br /> CD <br /> SIGN HERE1�1� <br /> a : <br /> (sig'na�, e of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR ulm 1 <br /> 1.9 69 di EA-N <br /> N N N N O O <br /> Cn0 (n cT00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />