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Burnett County 7410 Co. Rd. K,No. 102, Siren,WI 54872 Office of Zoning Administrator -0 o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> y O <br /> y <br /> C <br /> W <br /> OWNER n.fit S• w aI 5 h TELEPHONE -7 �� <br /> MAILINGADDRESS `58 1 / T(�\r�� _ 7 Dy, 1 `Ju o4 , W 1 iDJO r <br /> r7 J <br /> PROPERTYADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) t10 I C S r ' 1 V 15P2-2- ( &L)v L o/ y ) � <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE Y ADDITION ❑ �U) O (p <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: n zx�i <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) U 17.,:, c0 <br /> f � <br /> BUILDING CONTRACTOR: C <br /> to / m <br /> CD <br /> v C <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. 0 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> -nZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 5 m Q� <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 9 <br /> NORTH(N). CCn r 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m a <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF — 1 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 I O <br /> BUILDINGS, ROADS, LAKE,LOT LINES. w <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 /> O � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a <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 /> ISSUANCE. ^` <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. w <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> CD W 0 r D O n 0 -0 <br /> 6. m x9 �am � � � � <br /> a o m cy o g <br /> 7. cin � o <br /> Z <br /> m ,< <br /> I declare that this application (including an accompanying schedule has been examined b me and to the best of m — t^ iA : A <br /> PP (� 9 Y Y 9 ) Y Y i !j <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m0 <br /> m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize c me <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- �' (n <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 o <br /> providing in this application. I a re to ermit o ials charged with administering county ordinances or other o N p <br /> authorized person to have s t thea d ibed emises at any reasonable time for the purpose of inspection. ° 'o <br /> -n <br /> CID m a <br /> SIGN HERE <br /> at a of-oer or building contractor) _ i i i 0 <br /> l) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP <br /> _ <br /> O UI O CT (T O <br /> AY <br /> THIS PERMIT HALL EXPIRE ONE A ARF FROM DATE 0 ISSUXIQCE - <br /> Rt IRNETT COUNTY <br />