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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator ' 0 0 <br /> CD APPLICATION FOR LAND USE PERMITS LID y r O <br /> N O <br /> OWNER ! TELEPHONE �S�-�S^Z ' ��S^ / o <br /> V4 <br /> L j/ IW <br /> ,.^ m <br /> MAILING ADDRESS V4 (/ K/iV�f%S,J�GI �/L j/✓L 4'--' IWA-1 j Z Z,— <br /> �/ m <br /> PROPERTY ADDRESS V3135 AUl G� f�ii�fes(/ ��J✓1 �o <br /> LEGAL DESCRIPTION(see tax receipt) tL l 5 St.(,� 011 T3 1? t` 17 <br /> m <br /> DWELLING/BUILDING M GARAGE/ACCESSORY STRUCTURE ❑ ADDITION 0 <br /> TYPE OF PERMIT(S): ii <br /> FILLINGIGRADING ElCAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: Neto owant 0 <br /> (Hom /Cabin; Commercial Business; Bedroom; Deck; etc.) m <br /> m <br /> BUILDING CONTRACTOR: tZ m <br /> v <br /> CD <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 /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> m <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. t7 m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m r? <br /> NORTH(N). y o <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 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 t <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 ll" <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. 2 t <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <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. G <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. <br /> X oohs 0oDOm <br /> 6. m x3 nm Ox L' ,y <br /> 'O 0 N C y y 0 = ic <br /> 0 0 T� m <br /> U) Q <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G7 c C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of J? i <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CD c ' m <br /> m : <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- s <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 d 0 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> m : <br /> authorized person Mpvqjaccesi t e Oyiye d9scribed premises at any reasonable t1 <br /> -nCD n ; <br /> Lf CD a <br /> SIGN HERE L �' C <br /> gnat a of owner r building contractor) (date) 0 <br /> S P 2- 2005 ' <br /> � <br /> ZONING ADMINISTRATOR � <br /> Cin en <br /> (r,ONN W W O <br /> TOWNSHIP PERMITS MAY BE REQUIRED BURNETT COUNTY C o a a <br /> TRL5 PERMIT SHAT E SUANGQNING <br /> 14 12 1— ' P oli gertnc(;�d� -Bi iI <br /> iib Hee <br />