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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator T o 0 <br /> APPLICATION FOR LAND USE PERMITSCD. <br /> N <br /> OWNER TELEPHONE /Z 0 25 T o <br /> /�2 ✓r,n Q/ Se�1 d <br /> MAILINGADDRESS 3Ave S6 SS 3 <br /> r m <br /> p� _ o <br /> PROPERTY ADDRESS 2 Q �7 �� �� Q Qr S <br /> LEGAL DESCRIPTION(see tax receipt) / �/O ��S Csd✓ � t L�/��(s l9 r0 yUG m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE 19 ADDITION ❑ e Cn <br /> TYPE OF PERMIT(S): <br /> c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ < <br /> STRUCTURE/ADDITION USE: /I,/- x a 6tJ > !/l 6 X O de CK, <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: 5-1z QiJ`'v '4 -5/Ld,-Z S v <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE ORn 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o G <br /> O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <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 S <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. P <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 /> S. 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 2 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN v o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER Or` <br /> SETBACK AREA.-L-, CkJ�l -*v/ ' ` O� ' - '" � � 0, ✓ S <br /> 5. fir^ii r(.i <br /> 8 CL 20 Ox <br /> N N _ <br /> recur✓ � � y �' cox �/ x ,fid -, <br /> : � rn <br /> Cn <br /> 1 declare that this application (including any accompanying schedule) has been examined by me an to the best of my G) c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of na <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize a , m m O my <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether <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 otherr�o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. W. `D o <br /> CDm <br /> SIGN HERE 7--3 'a <br /> (signature orAoor building co ct ) 1 (date) <br /> ZONING ADMINISTRATORw_d+ <br /> NOO <br /> Ut <br /> TOWCHIP PERMITS MAY BE REQUIRED 0 (l1 NOO <br />