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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> OWNER J�hl�ssC�(� TELEPHONE <br /> -1 a5- 497- a��17 � 0 <br /> MAILING ADDRESS C EA A O <br /> ��S 0!:;cEcra tti>z <br /> 54 <br /> 0 O <br /> r � <br /> 0 <br /> PROPERTYADDRESS <br /> LEGAL DESCRIPTIONse x receipt) <br /> Stec 35 T y (tom bt� n1 <br /> DESCRIPTION(see LOt. <br /> N <br /> I� n <br /> DWELLING/BUILDING ` GARAGE/ACCESSORY STRUCTURE ❑ ADDITION o <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING X CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> S <br /> STRUCTURE/ADDITION USE: dL <br /> to Qt1af�. 0 <br /> (Ho a/Cabin; Commercial Business; Bedroom; Deck; etc.) N <br /> BUILDING CONTRACTOR: O <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 f, <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. In <br /> A ^ <br /> DIRECTIONS FOR PLOT PLAN DRAWING- (AERIAL OR TOP VIEW) O m <br /> T n <br /> ?I O 2 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 0 m p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m :? <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 \ 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. t 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. t C, <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 L) <br /> MUST BE SIGNED AND DATED BY THE OWNER. 51 <br /> 1 <br /> o 0 <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN g <br /> NEEDED. n rvr.,1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: p <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT CA� <br /> ISSUANCE. W <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY C7 <br /> PERMITTED. (n <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> ;1 Wr D O DO M <br /> n, c W m0M m <br /> 6. F B a m x a A <br /> a <br /> 7. Z omC � r.' o � 3 <br /> cin � o � m <br /> P m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of my - ^' O <br /> PP , 9 Y 1 Y c V : C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of �' [ 'm n : 0 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m c f 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 1 am <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. <br /> e Di <br /> SIGN HERE <br /> (slgnatur of�oyw�ner or �Ylding contractor) (date) 5 <br /> ZONING ADMINISTRATOR �A l 1 —An IlI n <br /> �fA fR fA Ge-+ N <br /> O N N W W N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS TJfLAPIR DATE OF <br /> I�SN <br /> )/ nf .1 uPy &any Ve/hassl <br />