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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 /> _ r <br /> w O <br /> N <br /> C <br /> OWNER TELEPHONE '<� L<11 q 1 <br /> v <br /> v <br /> _ m <br /> MAILINGADDRESS O <br /> \ �l r <br /> PROPERTY ADDRESS 1 J LA g V ° <br /> LEGAL DESCRIPTION(see tax receipt)`�-X'-v 13 -Ci�� Q• �� LD� �. C�1q V Q ��p� ►� * JQ C ` <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ to 0 <br /> TYPE OF PERMIT(S): � <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITIONOSE: �Cw-re-' ° <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) (n <br /> _ m <br /> BUILDING CONTRACTOR: d <br /> m <br /> m <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. <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> -n <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). y � j o <br /> 3 .SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m r+ /�� 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF �iJ t Z <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ( l P <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. 1 C� <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FD. ( N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTR .,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. \ o <br /> o J . <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICAT N MAY B � � o <br /> NEEDED. J <br /> UH 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. p 7c <br /> CONDITIONS OF PERMIT: eL9NF mow_ p <br /> I <br /> ISSUANCE.VEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I ,Y <br /> Q A'^ �A'✓� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. /Y�7 'Y v <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. psi E� (p a3 e'C' <br /> m m d O v a F M <br /> (-°p C <br /> 7Z N O <br /> . O O <br /> O T G Z1 <br /> m <br /> I declare that this application(including any accompanying schedule) has been examined by me and to the best of my G)c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m r, : 69: <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- (D <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 /> providinhis application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorizLarson to have access to the bove describe remises at any reasonable time for the purpose of inspection. fD o <br /> SIGN HEI� <br /> R . <br /> n <br /> sre caner or but g contractor) (date) <br /> �ignna <br /> ZONING ADMINISTRATOR j Imn I . <br /> : �N) <br /> Mf MK) 0N <br /> -7 517 <br /> -S - N 0 N N O(T (1. 00 O <br /> tT <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> / V X&2( 3 f►- f}Cc-- <br />