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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 /> V O <br /> N <br /> OWNER \ C (,�(� l!✓� � TELEPHONE v <br /> h� <br /> MAILING ADDRESS , Q <br /> / f r <br /> PROPERTY ADDRESS <br /> 9Ec( 3,S <br /> — <br /> LEGAL DESCRIPTION(see tax receipt) Ll 0M yg P 3�, fi �G -/X� <br /> l�J n �_ <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE L2Q�ADDITION ❑ n cn o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT SUBDIVISION ❑ Lai <br /> STRUCTUREIADDITIONUSE: T 0 <br /> (Home/Cabin ommercisine ;Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: I/,5o III v, <br /> l <br /> N <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n (b <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> �tl N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> -n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C m n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE W <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO mL 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. o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO \ CX <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 6. 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, CO CTOR, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. ) <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERT AT N <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. tIU o I <br /> CONDITIONS OF PERMIT: �' 6 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERNN44o �' <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. AI&I U/vry (^ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY l J <br /> PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> Lyy fl.yGl'�-� L.if "" LSP/ C Q m uni w o n m <br /> 6. m 3 a m x n m <br /> CD Cy " 'o' er 3 <br /> 7. Z N 0Z,;? <br /> l0 <br /> O -n G <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o » - <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize ° o : O <br /> that this information I 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 d : <br /> providing in this application. I agree to permit conn officials charged with administering county ordinances or other o <br /> authorized person to accessAo th abovescr' d premises at any reasonable time for the purpose of inspection. `° <br /> o : <br /> m m : <br /> SIGN HERE a <br /> sig ure f owner or uildin t (date) <br /> ZONING ADMINISTRATOR r� <br /> l EA fA EA Iq N <br /> --- "" e-. N Cn N N 0 0 <br /> •-( Ui O U (T O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED �V <br />