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Burnett County 7410 Co. Rd.K, No. 102, Siren,W154872 Office of Zoning Administrator CD o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> y O <br /> N <br /> -Z <br /> ct �(� <br /> Q N <br /> OWNER � + K���,� TELEPHONE 715- p�6 " Ste- I ' O <br /> O <br /> / 93o <br /> MAILINGADDRESS 7 <br /> U,) m <br /> PROPERTY ADDRESS 5A iv� cn <br /> CXl <br /> LEGAL DESCRIPTION(see tax receipt) �-() 1} <br /> �� I IL I op KI A)IJ S k U rn.S J <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ r m <br /> TYPE OF PERMIT(S): ❑ Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION <br /> STRUCTURE/ADDITIONUSE: 1 icl I f7J v U Gs 1/kt + IN,I�cI I <br /> (Home/Cabin; Cdrhmercial Business;Bedroom,Deck,etc.) m O <br /> BUILDING CONTRACTOR: <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAP :"ANY INCOMPLETE OR3. <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. nO'�b Owr- ; y Cj <br /> I <br /> 3 <br /> l yr °pd <br /> 011 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) -n n n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SC E. m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE o <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m .'a <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF , o <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO \)) SO <br /> BUILDINGS,ROADS,LAKE,LOT LINES. (� <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADOR_%LED. o C> <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILD R, IN AC�dR; T ,'IPLANS Op 02. � 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> L� O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE V RIFICATION MAY BE DONE W EN = o <br /> NEEDED. 'f. 2003 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. BURINETT C p I <br /> CONDITIONS OF PERMIT: AUNTY D <br /> 7 N1Nr`. � I DJ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. �0 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Q <br /> PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. A n r D O D a a <br /> m dw0mc. fm <br /> 3 am Faro M <br /> 6. myN � � � 3 <br /> Z N O <br /> O n� :a <br /> 7. m <br /> cn <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of Q a <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize )✓" ID Cl : rn <br /> ^� <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- G): <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 v <br /> d <br /> providing in this application. I agree to permit county officials charged with roistering county ordinances or other o . <br /> authorized person t e acce s o t ove described premises at any rea nable time for the purpose of inspection. -n ° o <br /> fD m <br /> / m <br /> � m <br /> SIGN HERE <br /> t �--- b3 Cl <br /> (signature of ow r o builds ntractor) (date) <br /> ZONING ADMINISTRATOR <br /> L" <br /> U1 O O <br /> T SHIP PERMITS MAY BE REQUIRED V <br />