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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. IC <br /> r <br /> // N 0 <br /> CD <br /> OWNER a A✓(`ti Q„n Q TELEPHONE �D -� <br /> r 51- '�3�- &3yb n o ti <br /> �[ t <br /> MAILING ADDRESS L17 o LO wL 5 L o,,,(� �tl}cj'1 (ver„—q �v( S 5,o <br /> o W <br /> PROPERTYADDRESS -731 ak5 <br /> LEGAL DESCRIPTION(see tax receipt) 0'1 7- (37-p d 3 — 1'ov m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE T� ADDITION ❑ Cn 0 <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: b A A t� e/ C� �C <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) m <br /> BUILDING CONTRACTOR: S ``�f <br /> P <br /> M <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> x N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) OT o <br /> ?t o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m X <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). CCA o <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 o <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 I <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Z N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACT ETC., THE PLANS 0 1� <br /> MUST BE SIGNED AND DATED BY THE OWNER. J O 1 <br /> q ' ( R <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION A � o, <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. JUN 1 ? <br /> CONDITIONS OF PERMIT: eV ?QQ2 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT RNerr CC ISSUANC <br /> 2. REMOVAL CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ��N>'NG UN oo <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY (( G <br /> PERMITTED. fll/I <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SE ACK AREA. <br /> 5. <br /> P4✓ Cit.-1.-r.., � �u LL"°��- m ani r chi my Da O � <br /> w <br /> 3 a (03Ox a m A <br /> 6. <br /> O (gyp C H N 0 � 3 <br /> y (.0O O t0 <br /> 7. O iT� <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my L) C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m o mm <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 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 de cribed premises at any reasonable time for the purpose of inspection. m a o <br /> m (D <br /> cn m <br /> SIGN HERE <br /> n : <br /> (sign of own r wilding contractor) Ida ) <br /> ZONING ADMINISTRATOR `) <br /> (� EA f0 N <br /> N 01(T NN NOO <br /> OlOOI (TOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />