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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator M o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N 0 <br /> N <br /> OWNER �CT JC rl � TELEPHONE �j�5--S l�l_ <br /> Vf .\ v <br /> � ° <br /> MAILINGADDRESS �� 2. / I��y n�yl O <br /> t � <br /> r <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADgg41TION LJ (n <br /> TYPE OF PERMIT(S): /) �P.l (]/' <br /> FILLING/GRADING 1:1 CAMPING UNIT El SUBDIVISION ❑ �//�L 7l' a 1- <br /> y,L.K_!nl CLm`zrT . �'7(i �QtlG�`�0/�r�F/ <br /> STRUCTURE/ADDITION USE: W 0 <br /> ome/Cabi ; Co merci Business; Bedroom; ck; etc.) jj cry"` rn KJ <br /> jsBUILDING CONTRACTOR: m ' <br /> cx�r-i`CC <br /> c <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR _ <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O o A <br /> M <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n - <br /> T <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m :? <br /> NORTH(N). CJ <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO 05 <br /> m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S) MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <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 <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 I Q)o <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 1 <br /> o � <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 <br /> NEEDED. Q� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: <br /> W <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. W w <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 /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> m aa)m > pDa O t) <br /> 6. 0 > > nc� a � m <br /> m aro am >r � <br /> p N C_ y y o ] 3 <br /> 7. Z c �' O <br /> N T� m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m O <br /> PP ( 9 Y ) Y Y E c't 2 C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize m m <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 o0i o <br /> providing in this application. I agree to permit county officials charged with admini ,o <br /> authorized person to have access to the above described premises at any reasonaW h s 1 m <br /> T 6 <br /> n <br /> SIGN HERE <br /> (s gnawro of owner o(building contractor) (d to o <br /> APR 2 Z 1006 P <br /> ZONINGAD ST <br /> BURNE17 COUNTY O N N W W N O <br /> OUtOIn N (n0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING <br /> T IS PERMIT SHALL EXPIRE ONE YEAR FROM DAT 01 ISSUANCE <br /> pt <br /> nyA 4_ C.�� mal A"d -fZ -de <br /> 5-r d� <br />