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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> OWNER TELEPHONE 6/d-3q?, 3?( n <br /> I oAJ fsllncK <br /> Q ` A <br /> N <br /> MAILING ADDRESSj� N+� Qf�� r�y ��(`�/� ��rK ���, S�S3v O <br /> s r <br /> o <br /> PROPERTY ADDRESS a63d,), I OSe++ L K o RAm SVMNen <br /> I <br /> LEGAL DESCRIPTION(see tax receipt) (J u (3 <br /> m <br /> DWELLING/BUILDING ElGARAGEIACCESSORY STRUCTURE ADDITION Elrn <br /> TYPE OF PERMIT(S): n <br /> FILLINGIGRADINjiG))❑ ° <br /> CAMPING UNIT ❑ F-1SUBDIVISION <br /> STRUCTURE/ADDITION USE: Deo^ <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) m <br /> � Q <br /> BUILDING CONTRACTOR: <br /> v <br /> CD r ` <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/,X 11 SHEET OF PAPER. ANY INCOMPLETE OR _3 �U <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> ;o y <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> -n O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). tCp 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m ^� o <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. , ° <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. n- <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N ICJ <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS M. <br /> MUST BE SIGNED AND DATED BY THE OWNER. J o 4,0 <br /> 0 W <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. A <br /> I <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 Q <br /> ISSUANCE. Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 1-0 <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. ani o� ,per irn Flani9ctn -6r U acd ss <br /> �1 mDODO M <br /> 0 <br /> n � n n n � m <br /> 3 <br /> 6. m �c 3 <br /> 0 o m c y n o 3 <br /> Z c w o <br /> 7. om Tom : ;U- cn m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m O <br /> PP ( 9 Y ) Y Y C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of J v <br /> d C m <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> (n : C <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 0 <br /> providing in this application. I agree to permit county officials charged with a other j <br /> authorized person to have access to the above described premises at any reas m n <br /> SIGN HERE � I n <br /> Li n,ature of r ornla 'Id" contractor <br /> ZONING ADMINISTRATOR <br /> Ir J fa Ii' 9 ) uJ <br /> 91 <br /> �Jraq Ili_N_I TOWNSHIP PERMITS MAY BE REQUIRED ZIP !M0UN O N N W W N O <br /> &-a1-9� ov, ou, u, No <br /> THI PERMIT SHA4L EXPIRE ONE YEAR FROM AT F ISSUANC ONING <br /> }�e�m� �y mecca �h���� <br />