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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 G) Z <br /> APPLICATION FOR LAND USE PERMITS 3< <br /> r <br /> W O <br /> C _ <br /> I7 .}- �{ N \VVI <br /> MINER l hQb�e-I h D + F )y1� -am TELEPHONE <br /> , �15-�35—� �rp��] O � �R <br /> MAILING ADDRESS ,,� :?dO ��U(� 1 \/ <br /> Road 1 t W�.fef/ (. a. CcNO i -2 � �O 1 <br /> PROPERTYADDRESS <br /> L QTt2 OF SCJ UcirYeY �2_ ion t7 , ibw„�h:p <br /> LEGAL DESCRIPTION(see tax receipt) �� uc�h Runge i , T c w. orr �cc-F.{. / ( C0 <br /> kj <br /> m <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ rn o <br /> TYPE OF PERMIT(S): D v <br /> a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION C� <br /> STRUCTURE/ADDITION USE: H O M -r- <br /> (Home/Cabin; Commercial Business;Bedroom; Deck;etc.) (n <br /> BUILDING CONTRACTOR: `7Eu t' v' U) <br /> T <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T - <br /> O <br /> A H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> T n <br /> ID Z <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 9 <br /> NORTH(N). CCo UZI) <br /> n <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. 0 <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. o <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o Y <br /> CONDITIONS OF PERMIT: I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT r <br /> ISSUANCE. J lXll <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. OER�Vjg 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE I <br /> SETBACK AREA. <br /> 5. (pacl 3_3 <br /> "JUN w3 og 0ma � m <br /> 6. � 42003 � 3 a0 Oa � <br /> o m C N o 3 <br /> 7. <br /> BURNETr COUN Z <br /> I declare that this application (including any accompanying schedule) has been examined b N eGt the best of my of C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m 0 : d, <br /> CL 0, : M <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o : mm <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 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 <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 t'me for/the purpose of inspection. ° o <br /> SIGN HERE <br /> (sign re o owner or building contra or (date) (l a <br /> ZONING ADMINISTRATOR <br /> e <br /> fA di ffl fA N <br /> n � N (TNN <br /> TOWNSHIP PERMITS MAY BE REQUIRED / ?-,L1 Sa��! t+^y `� `� <br />