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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 7 <` o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> to O <br /> N 41 <br /> OWNER // ���/'/RTELEPHONE <br /> MAILINGADDRESS ,3'ZyD LE,Pa y/ <br /> n / <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION( receipt)tax recei t) SE SEif�ti 1 yY� /Y g Lu <br /> ,� J' Y <'$M <br /> w' Y LoT p <br /> DWELLING/BUILDING ElGARAGOACCESSORY STRUCTURE ElADDITION b1l 0 <br /> Q <br /> TYPE OF PERMIT(S): 4 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ N. <br /> STRUCTURE/ADDITION USE: <br /> R (Home/Cabin; Commercial Business; Bedroom, Deck, etc.) <br /> d <br /> BUILDING CONTRACTOR: ,2 t^ -4 <br /> A <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 .Q <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. '. <br /> A c �\ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) a <br /> � o � z 1 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m W A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m CS o <br /> NORTH(N). rn <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m b -30 <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. } 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. 1 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. C N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS I ,' ?. .4 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 <br /> O � I <br /> o Q\ <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED. <br /> Z <br /> (� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. „I <br /> CONDITIONS OF PERMIT: 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <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. iD ,W 0 M n f m <br /> n 3nm xnaA <br /> 6. z oy � o �' o� 3 <br /> P m I'Q <br /> �. m <br /> n: A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for my <br /> the detail and accuracy of of n <br /> her declare that I recognize m <br /> c <br /> all information contained in this application(including any accompanying schedule)and I furt : N mo <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> ng <br /> ; o <br /> sue a permit. I further accept all Iiabllity which may be a result of the County of Burnett relying on this Information I <br /> ounty ordinances or other <br /> providing in this application. I agree to permit county officials charged with administering c , <br /> authorize son hav ss to the above described premises at any reasonable time for the purpose of inspection. m a <br /> m ui <br /> SIGN H E <br /> net a of building contractor) (date) 0 <br /> ZONING ADMINISTRATO Fn w <br /> fA fA(A f9 N <br /> G ONO (WnNUO <br /> TOWNSHIP PERMITS MAY BE REQUIRED Q <br /> THI RMIT SHAL{ EXPIRE ONE YEAR F 0M DATE OF U/1NCE� <br /> rr�k + `y�r-�e,( maile d 7oTm ml ha� U <br />