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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator v 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> 5, O <br /> OWNER o UQ Q r 1 Q a J TELEPHONE d Nn <br /> 76 -y7y-ea o <br /> MAILING ADDRESS 31 0 CQ j c.l A09 m t V 1 nA n JV SS 35 y m F <br /> p <br /> m <br /> / I ky© W K <br /> PROPERTY ADDRESS I �Q COV,,Jj �� Z� y(0.�� SpVtoi WZ 5 ` i <br /> L/ <br /> LEGAL DESCRIPTION(see tax receipt) - � c�m V /8 10 -"6 7J a 8 —j✓l—— s I � <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ q 0 <br /> TYPE OF PERMIT(S): or T <br /> FILLING/GRA/I ❑ CAMPING <br /> ,om( , &/1'UNIT 14/ _SUBDIVISION /❑ CL <br /> STRUCTURE/ADDITION USE: J " "1 O C �OV� <br /> o <br /> (Home/Cabin; Commercial Business;Bedroom;Deck;etc.) C/) <br /> � <br /> d <br /> BUILDING CONTRACTOR: <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. m ' I I <br /> 0 uV <br /> y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p m <br /> -n a <br /> TZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n ov A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 9 _ <br /> NORTH(N). C -1�5 n(b <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 0 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF N Llp <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFI YME-DOME WHEN n o <br /> NEEDED. -,r lU Qb <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ✓ Z <br /> o ' <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF <br /> ISSUANCE. "uh(JVE� t <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SH <br /> ORELIN�O CQUN <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY NItVC, <br /> PERMITTED. <br /> 4, NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. ek <br /> f m <br /> 3 <br /> "O N C <br /> 7. Z N O <br /> O it <br /> declare that this application (including any accompanying schedule) has been examined by me and to the best of my N A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m n v, C <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize rh m , o <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- I M <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 d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to hayp access to the above described premises at any reasonable time for the purpose of inspection. m s <br /> T o : <br /> m m <br /> SIGN HEREQ �4� .19- 0 30 3 `^ <br /> n : <br /> (signature of r or building con tnor) (date) <br /> ZONING ADMINISTRATOR <br /> n fA fAN VI�N <br /> N (TNN O O <br /> NO [T (TOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />