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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v 0 z <br /> CD 0 <br /> APPLICATION FOR LAND USE PERMITS . o <br /> OWNEa <br /> R�� �n ^ 1 , (� TELEPHONE j- 3� g( -r <br /> Stu O 0 p <br /> MAILING ADDRESS I I rlCL Z VOLUN r c- k Rct i,1,".,.fif_(1Mr / mK E6) 1(1 T ? <br /> Lw J[]t...i 1lU Q7 r <br /> 0 <br /> PROPERTYADDRESS 1102- .' dr` <br /> LEGAL DESCRIPTION(see tax receipt \ co <br /> CD <br /> a k <br /> TYPE OF PERMIT(S): <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION u/ 0 m <br /> FILLING/GRADING ❑ CAMPING UNIT^❑ SUBDI ISION 1 <br /> STRUCTURE/ADDITION USE: � �p�V P/ �?C! JO //�/ U <br /> (Ho /Cabin;Commercial Business;ked ;D k;etc.) � \ <br /> BUILDING CONTRACTOR: <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. -n <br /> O <br /> rtl N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> n a Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. A v A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. z <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO 0 <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> r <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> CONDITIONS OF PERMIT: ° <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 <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 t„ <br /> PERMITTED. (i{ <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER \ <br /> SETBACK AREA. I" <br /> 5. <br /> m ° Of6. m = m a m <br /> m 30. x <br /> .� <br /> 7. Z N 0 y 0 <br /> p 21 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my (( ,,__ q p <br /> U. <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ` m n d, C <br /> all information contained in this application(including any accompanying schedule)and I further declare that Irecognize C o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> CD o <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 o� <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> n . <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> m 0 : <br /> CD m' <br /> SIGN HERE <br /> (signs of 6wrFer o d n (/date) a. : <br /> ZONING ADMINISTRATOR ! Z Q <br /> EA di fA Hi-N <br /> N Cn N N OO <br /> 0O (T (TOO <br /> TOWNS IP PERMITS MAY BE REQUIRED <br />