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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 /> N <br /> (/1 <br /> C <br /> l p 0_ <br /> �. TELEPHONE ��5� / �� j/ <br /> OWNE��I� `F 7Y t 7 n . Q f C �c, y v <br /> MAILING ADDRESS Lai <br /> I ski 3o 50 <br /> PROPERTYADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) / <br /> 1 p <br /> DWELLING/BUILDING In GARAGE/ACCESSORY STRUCTURE 1:1ADDITION co o ,Lt <br /> TYPE OF PERMIT(S): (��{/' a = l T <br /> FILLING/GRADING 1:1 CAMPING UNIT SUBDIVISION El / Z <br /> 1 <br /> H <br /> STRUCTURE/ADDITIONOSE: � � 7S � o /7 ���D 17 t0 N70 bi <br /> (Home/Cabin; Commercial Business;Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: b rit �JilO u e'rS a <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> TJ N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> C o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m 3 <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. ° <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. C)-f <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS C <br /> MUST BE SIGNED AND DATED BY THE OWNER. m <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFIC I ONE WHEN y 0 <br /> NEEDED. �IV ` C7Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. PC o <br /> CONDITIONS OF PERMIT: A14Y <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF¢Ff1Jy1►I. // <br /> "��fkISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELIN CQU <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY �/V/fV N7-' <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> M w <br /> W c a > 0- 0 <br /> m <br /> 6. 3 nm Oxa <br /> .a N i m m O 3 <br /> ZN N O <br /> 7. O n`z m <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. 1 acknowledge that I am responsible for the detail and accuracy of o N � <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m O M <br /> CD <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. ° o <br /> m m E <br /> ...�A � m <br /> SIGN HERE vy"'{ �� n <br /> (signa�J of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR `/ v,u> <br /> EA fA fA fA � N <br /> (T 010 N NOO <br /> O (T (TOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />