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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 1_. <br /> - r <br /> m o <br /> N <br /> C <br /> OWNER V e-'k /�(A"e' 1 TELEPHONE -7i_5- <br /> o <br /> a AFT `l <br /> MAILING ADDRESS ] (�• ��l t � � y . �s y �J f <br /> 0 <br /> PROPERTYADDRESS C4,6, <br /> G <br /> LEGAL DESCRIPTION(see tax receipt) ;C4 J- j3— /S— <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ rn 0 <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: U M�� o�C� X 7 / �/ UX"� -L r I <br /> �0 (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) a-kid rn <br /> CA BUILDING CONTRACTOR: AT GaAChe� a /'I p.Su A►�"1 �~ L L(Syfi m <br /> 3 � hC, JA, 0 <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. T <br /> �ZI m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) Om <br /> n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m T <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO mB <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF I a <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(OF),AND ALL DISTANCES TO <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRAS ED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER/ C �E THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. n o <br /> O � t <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE V$� ICATI MAY BED � � <br /> NEEDED. J l vi; <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. BURN "`"✓ U l o <br /> CONDITIONS OF PERMIT: O CO N �1 <br /> 12 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT NTNG �' 1 <br /> ISSUANCE. 11 C <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY W 1 G <br /> PERMITTED. (gyp <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. (0y)ST6e) /7-N-03 <br /> 6 <br /> 6. 3 n N n m <br /> �e�z j6 01 k, e �N W o - 3 <br /> 7. Z N o : 1 <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of w n v+ <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o mo <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 w <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. ° o <br /> m m : <br /> CD <br /> iw <br /> SIGN HERE �1 / 1 ( 0 OR <br /> (signature of owner or building contractor) (date) . <br /> ZONING ADMINISTRATOR / l(d71(` <br /> J fA fA to W — N <br /> N <br /> 0 N O O <br /> fl, O (f� N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />