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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 /> N O <br /> W <br /> OWNER £<rjC <br /> taJN rJ s�--1l- U-C.6` <br /> \ LTELEPHONE95,1-5,1-0 y G I — O/ )Y D- o <br /> d <br /> �J m <br /> MAILINGADDRESS 3 7 ��� (J/ �A zG fA �n,. Ss3�j 1 v O <br /> r � <br /> PROPERTYADDRESS <br /> o <br /> LEGAL DESCRIPTION(see tax receipt) m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> TYPE OF PERMIT(S): v ' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ CL <br /> STRUCTURE/ADDITIONUSE: 1..I2I1sr, Areu �a0Acs 1 4 eXte,, cJ <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) m /1 <br /> m V� <br /> BUILDING CONTRACTOR: S P_I � r <br /> m <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 0 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. ^ <br /> ;a H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n R A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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. <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 t <br /> MUST BE SIGNED AND DATED BY THE OWNER. o / <br /> o w <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 <br /> NEEDED. n W <br /> r. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> l <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT W <br /> ISSUANCE. r ` <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. V 0 <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER n ' <br /> SETBACK AREA. /�J d �'� IY <br /> Nie (mss �� t56'), , —tot M o r > o a o <br /> /�� p/ 3 'a $ y n <br /> L2 tc� �L/41 T� S�oCS1 , �— 4455 H�&N /o IhGIEY*{ a m c o 3 <br /> 7. Z Nm ° .' � 7 <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 1 am responsible for the detail and accuracy of m cn <br /> cn : <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CL(D O mt7 <br /> that this information I am providing will be relied upon by the unty of Burnett Wisconsin in determining whether to is- <br /> sue a permit. I further accept all liability which7escri <br /> y b a resu of the County of Burnett relying on this information 1 am d <br /> providing in this applic n. I agr a to permiun offici charged with administering county ordinances or other <br /> authorized person to v acces the above d pre ses at any reasonable time for the purpose of inspection. m m c <br /> o <br /> CD <br /> CD <br /> �4 ;Nqh .zd�3 M <br /> SIGN HER cl : <br /> signature of owher or builbVig contractor) (date) <br /> ZONING ADMINISTRATOR a" F-06 �A � <br /> fA M <br /> N dN <br /> N U O <br /> N O N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />