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IL <br /> Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator - c�r� —L o <br /> APPLICATION FOR LAND USE PERMITS 3. < <br /> ur <br /> C' <br /> Cu 6a ( ^ <br /> OWNER ^ TELEPHONE <br /> 1JQYtJ. h lL n4�G kn <br /> MAILING ADDRESS � � � j'1 <br /> PROPERTY ADDRESS <br /> ,)9196 <br /> W Yq AIR-1 /vru) culr^ _ <br /> LEGAL DESCRIPTION(see tax receipt)-1 o-",qo--Iyyi NSN/ /� Clt�Ale4k Tt_ SP <br /> DWELLING/BUILDING 1:1GARAGE/ACCESSORY STRUCTURE K ADDITION ❑ U) 0 <br /> TYPE OF PERMIT(S): Q a <br /> FILLING/GRADING ❑ CAMPING UNIITi 1:1SUBDIVISION ❑ < <br /> STRUCTURE/ADDITIONUSE: .��� X 7 f l7OrdGX , �O ? CL /Eft E'/�/� �-adK 0 7✓ <br /> (Ho a/Cabin; ComnSdrciaf Business;Bedroom; Deck,etc.) <br /> BUILDING CONTRACTOR: CD <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR In 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 ^ <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a V T <br /> TZ \' <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 6 o X <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m a <br /> NORTH(N). C 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 <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o 0LA <br /> Z <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 / p` <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 SPE%ICALLY <br /> � <br /> PERMITTED. a <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> N N n n C F m <br /> 6. m 3 am 0 ': cD � <br /> a m y y y > > 9 <br /> 7. Z m ,p O <0 <br /> O T m <br /> m <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 1 am responsible for the detail and accuracy of u 0 'W c <br /> n ^ : � : % <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o : 0 <br /> CD <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- Q <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 o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m CD o <br /> m m <br /> SIGN HERE r8✓' s <br /> n : <br /> (signature of owner or i contractor) ( ate) <br /> f <br /> ZONING ADMINISTRATOR <br /> Q <br /> N EA<j N 0 N N (T N N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED V <br /> Oa-yva <br />