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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator v 0Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N 0 <br /> 78 N <br /> 0 <br /> ^� ^ 1 � <br /> OWNER i : IOo AJ �[L C]�`e h TELEPHONE �/ v <br /> A) <br /> -7 �/ I v O <br /> MAILING ADDRESS �o(,�d j.Q e �I /g�Jb_ 14 In!4— &)-rs7qk-b r m <br /> PROPERTYADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) <br /> PC,,L Q01 1-7- 3-.� I y I N 1� � bj o' <br /> CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE N ADDITION ❑ 0 <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISI N ❑ <br /> StoraU� y <br /> STRUCTURE/ADDITION USE: 0 <br /> (Home/C ; Commercial Business;Bedroom; Deck;etc.) y O <br /> m <br /> BUILDING CONTRACTOR: C�T <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/r X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> ;a N om) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> m <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 S <br /> NORTH(N). <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m ti 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. 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 /> 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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. -oma <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT W <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. Y S� 8ccr/�/h <br /> 6. /�/ leS y e (o un, =0 MQ : m <br /> J (2 3 am �c �_ .O <br /> "O N <br /> O T r� <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my - �^ A <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of m n v, c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CD CLF o 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. I further accept all liability which may be a result of the County of Burnett relying on this information I am o� <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. m o <br /> CD <br /> CD <br /> SIGN HERE a `^ <br /> a : <br /> (signature of owner or builds contr c r) - /(date) '. <br /> ZONING ADMINISTRATOR <br /> EA fA to r/ 0 N <br /> N V N N O O <br /> N O (T (r O O <br /> TOWNSHIP ERMITS MAY BE REQUIRED <br />