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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator o° o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> o <br /> N <br /> C <br /> N <br /> f� _ � <br /> OWNER � y-,) �'ef� �'e� 1'C{ Lh°✓[". TELEPHONE <br /> 91 V v <br /> `= O <br /> MAILING ADDRESS -��eo'x _ y ,r,g. RjC41 i'1 �', <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) 4 p(mS� <br /> 7� <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION ❑ <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING_UNIT 1:1 SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: -\1.)'e-C_.h ��• �� ' (}) <br /> (Home/Cabin; Commercial Bus ass; Bedroom, Deck, etc.) C T d <br /> �. <br /> BUILDING CONTRACTOR: <br /> v <br /> m �( <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. O J <br /> M c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O Z n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n R <br /> m m^ <br /> A \ <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m O <br /> NORTH(N). fn �,� n^ 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m `iV VJ-9 <br /> CENTERLINE OF ROAD,(C)BUILDING(S) MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF w Z <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 0 'O <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO 1 <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 o 1 2. o <br /> MUST BE SIGNED AND DATED BY THE OWNER. IY 1 <br /> O � <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN o� I } <br /> NEEDED. V o\ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: rQr� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT O T <br /> ISSUANCE. /A <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. \ v ) <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY a <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. 0r D0D 0 -13 <br /> � mmnMafm <br /> 2 ox a m <br /> 6. <br /> Z cwmo -i <br /> 7. o m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Q 2 C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of n c I A <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize : rn m0 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ! o <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person t h ve access to the abov described premises at any reasonable time fo h p " n <br /> 5 n <br /> a <br /> SIGN HERE o <br /> ( na owne r uilding contractor) (date) <br /> n <br /> ZONING ADMINISTRATOR <br /> �63 fA 63M� N <br /> NONO (n N OO <br /> A-4 Jed <br /> PERMITS MAfY_BE REQUIREDQ� BURNETT COUNTY <br /> T ��((lt,'T {C�'�-1EAI�UFROM <br /> D�YI�-Yc(XSS� fvlV(�IS,��{l <br />