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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o° o <br /> CID APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> CD <br /> CD o <br /> OWNER TELEPHONE rlj3S 7�g— <br /> MAILINGADDRESS <br /> f - o m <br /> PROPERTY ADDRESS Ilacr �,[Q�e n �ol PO//s�' AIX- 1C� <br /> I \ <br /> LEGAL DESCRIPTION(see tax receipt) Q � <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ to o <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ w <br /> STRUCTURE/ADDITION USE: -y7GPs rw1aClr"t', W If1 wGbCUn L S o W <br /> (Home/C bin; Commekial Business; Bedroom; Deck; etc.) cn <br /> BUILDING CONTRACTOR: �T C&S -5 o�7-PS jp,/tqo'8 m CACD con <br /> S <br /> C <br /> I <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR p <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p y <br /> .Zl ti <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). CA - I " o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S)TO m <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF J Z <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 0 <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO (fit <br /> BUILDINGS, ROADS, LAKE, LOT LINES. y/ :�E <br /> S. 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 > <br /> MUST BE SIGNED AND DATED BY THE OWNER. Q o o <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 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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 O <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> M m w r >0 DQ 0 <br /> 6. x 3 n m y a m ;0 <br /> -o o m (Z <br /> 7. Z c v CD o <br /> o m Tom : A <br /> = w m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c A <br /> knowledge and belief it is true, correct and complete. 1 acknowledge that 1 am responsible for the detail and accuracy ofo c <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize m c m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m 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 �' m o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other tD <br /> authorized person to have acless to the above desc 'bed pregaises at any reasonable time for the purpose of inspection. `D a <br /> -n <br /> CD a <br /> N <br /> SIGN HERE 7—/1,,- <br /> (sign a owner ing contractor) (date) 0� <br /> ZONING ADMINISTRATORinA <br /> v O N 01 W W N O <br /> O Ut O Ul (n Ul O <br /> T NSHIP PERM S MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FRODAT F ISS NC <br />