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Burnett County 7410 Co. Rd. K, No. 102, Siren,W154872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> V7 0r <br /> OWNER �a,rn 1� C'r TELEPHONE (• "S'o7�� F7 �O 0 �. <br /> d <br /> �) m <br /> MAILING ADDRESS 0 3'1 ��rk �qy� /�t k f/\'f%�t r t7 f!�r$ j�/ '5 J ClC9 7 <br /> PROPERTY ADDRESS 9� ° <br /> r <br /> a 9 S I O n �"f l�/�N �lt�-CCE . I,�A-fl���n.r U � SiS�� \ ° <br /> LEGAL DESCRIPTION(see tax receipt) L.-G ij-flay d cn LaKt- 0-t- l S. T qo IQ, �(p W <br /> DWELLING/BUILDING ;< GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ y �` <br /> TYPE OF PERMIT(S): <br /> a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITIOINUSE: i P L 0 <br /> e abin,Commercial Business;Bedroom; Deck;etc.) rn <br /> BUILDING CONTRACTOR: / \ 4t5 v'r7Yc�•��C\Y� E b${ir ll '- <br /> m <br /> M i <br /> N <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 00 Z <br /> C an S/'k ok j a-moo ot( n <br /> Ay c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> 21 <br /> 1. ALL REQUIRED(DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. t7 m Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). CO) \ o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF ` Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. p o <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO T <br /> BUILDINGS,ROADS, LAKE, LOT LINES. � Q <br /> 5. INDICATE IFA WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. J o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. o d <br /> NOTE: BUILDINGI$TRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PE$MIT: P (� f <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Q <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; <br /> 5. <br /> A 0 > 0 > 0 -0 <br /> °a Ox <br /> 6. 3 m <br /> a' m C7. <br /> N m o 3 <br /> p iii M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 11F <br /> c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize O m o 0 <br /> that this informationI 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 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. `° o <br /> SIGN HERE <br /> (signatupre6of ner or contractor) (date) a <br /> C> <br /> ZONING ADMINISTRATOR v <br /> G Fn<ncnE»�'n"i <br /> G cNnocNn �oo <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> by �,��-t-�i.s Co�>� <br />