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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator vG) z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> r -77�- Xo5%/ /f <br /> OWNER j7e 1 �V, fJ,°V'\'% ally TELEPHON 6 S/- �/ D- D l 3 o <br /> MAILING ADDRESS q6 C) lyge- �jelx ©C[' 'Ale M/tj 551.3 o � <br /> r � <br /> 0 <br /> PROPERTY ADDRESS 30D(s? ts Lx. D�4r�Rkti" (✓ S`/Y�a ^� <br /> LEGAL DESCRIPTION(see tax receipt) 5A,,,,E <br /> DWELLINGIBUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION I�,j1 C)` 0 <br /> TYPE OF PERMIT(S): V <br /> FILLING/GRADING ❑ SUBDIVISION ❑ 0' <br /> ❑ CAMPING UNIT � <br /> STRUCTURE/ADDITIONUSE: 3 .S&I-SO/U /7jffC/r 0 <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) ` <br /> m 'rV <br /> BUILDING CONTRACTOR: N�Nt m <br /> Z � <br /> CD <br /> v <br /> I <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR OT Q <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> M m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> 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 ( 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. `I <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. �J <br /> S. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS l�} <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 7� <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 <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 WAT R <br /> SETBACK AREA. , re�1 /NG / <br /> ` I �n� l7 /y1 ecf 7 J '/ S <br /> m 0 0(a f T <br /> ,v�t� - a ���►� - /ss o �t.r ,wcrt ,� v fi�w ,c c,w i N � N <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of myG) ID <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d n En <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize (D o G <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- i 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 O' <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. r m Cn <br /> o : <br /> CD m : <br /> SIGN HERE ,SJ,3o/19-3 <br /> RVn : <br /> is at re of <br /> rr building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> fNA f(AT K3 fNA 0O NO <br /> TOWNITS MAY BE REQUIRED T O TOO <br />