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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator v c) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> - r <br /> N O <br /> OWNER a/WL L ! ��IG�SCIeTELEPHQNE p <br /> ff- o U <br /> MAILING ADDRESS �� G`=`i✓GCS J v 7v o f0 <br /> PROPERTYADDRESS 174 /5- Di-- i <br /> S L3 CS Vl ' � � <br /> LEGAL DESCRIPTION(see tax receipt)G-Ly f- <br /> C <br /> S <br /> DWELLING/BUILDING 11GARAGE/ACCESSORY ARUCTURE ADDITION ❑ y r- <br /> TYPE OF PERMIT(S): CC <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> ! < N <br /> S� v <br /> STRUCTURE/ADDITION USE: �\Y Lid 6i o I�) <br /> (Hom C bin;Commercial Business;Bedroom; Decl- tc.) ' <br /> BUILDING CONTRACTOR: NEW W02LI-) -5f S7l2ULT/ate — 144RAV LSNDke <br /> Q <br /> v <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. -n <br /> O <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O CD <' 610 <br /> n n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. TI Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> m <br /> NORTH(N). C C) <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO CO) 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 7 <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. <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 0 i <br /> MUST BE SIGNED AND DATED BY THE OWNER. a <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <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 WATER <br /> SETBACK AREA <br /> a Fam Acca <br /> a m C y ^ o <br /> 7. Z N m o 1 <br /> p -nomX <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my - - O <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of U' m n d, C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <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. 1 further accept all liability which may be a result of the County of Burnett relying on this information I am m <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other <br /> o : <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. � <br /> M o <br /> SIGN HERE <br /> (Aifnatureoffabuilding contractor) °' <br /> (date) <br /> ZONING ADMINISTRATORbe <br /> U) <br /> EA EA ER 6e b N <br /> N N N N O O <br /> NOU (TOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />