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Burnett County 7410 Co. Rd. K, No.102,Siren,WI 54872 Office of Zoning Administrator 'o o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> m O <br /> C �V <br /> fD <br /> OWNERRruc.,e- 13 ,^�U TELEPHONE o �Jy <br /> Pm <br /> O <br /> MAILING ADDRESS N 1431 60N r • F <br /> ^ 0 <br /> C G <br /> PROPERTY ADDRESS S pppNerI <br /> 1 1 ]'� r <br /> LEGAL DESCRIPTION(see tax receipt) UI > y�� /n ��i ai5 - 5� �k Uj <br /> m <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ , O <br /> TYPE OF PERMIT(S): ra n <br /> FILLING/G DING ❑ CAMPING UNIT ❑ SUBDIVISION <br /> /� ( Uki <br /> STRUCTURE/ADDITION USE: ��� r`L�Orf "'� "` `" y ��" <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: <br /> v <br /> � c <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/a X 11 SHEET OF PAPER. ANY 1NCOMP ETE OR/ I -n 3 G <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. S'AP �rm/T 1 U �P � N G \1 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) �C �S n a <br /> T v z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 9 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m n <br /> NORTH(N). 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 9 <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. <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. ° �C <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° <br /> NEEDED. �' <br /> CA <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: bbb L ` <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. O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY U <br /> PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. m 0r - 10, <br /> vnvv <br /> �0 3 A On <br /> 6. (DC 0S3 <br /> Z N O <br /> 7. -n" m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my , <br /> ID <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o 01 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize O (D <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- G) <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 county officials charged with administering county ordinances or other o <br /> authorized person to have access to the above scribed premises at any reasonable time for the purpose of inspection. - ° o <br /> m m <br /> -a3-3 S : <br /> AA 4u <br /> SIGN HERE a <br /> gnat a of ow o in c ntractor) (date) <br /> ZONING ADMINISTRATOR ' <br /> 1»1n<n En <br /> N(TNN O <br /> (T O Vt N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />