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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. ( �1 <br /> OWNER t c�olctS {- �u.�\Q, 1 •� -(Ch('�C��1 0 TELEPHONE Cc�J 5 y. q 30"1 <br /> o <br /> ° <br /> MAILING ADDRESS <br /> PROPERTYADDRESS a-1a.-1 1 Q ��J�, NOC% A 1 0 <br /> Pm <br /> LEGAL DESCRIPTION t) rn <br /> (see tax receipt) <br /> DWELLING/BUILDING ® GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ 1 n Cn ° <br /> TYPE OF PERMIT(S): 1 C <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ < <br /> STRUCTURE/ADDITION USE: 1 CY'1 '�I Cab-1 C) ° <br /> 0 <br /> M j <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) ( 1 <br /> BUILDING CONTRACTOR: <br /> m (b <br /> m <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. O <br /> M <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> ?+ o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n v A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m c(�J <br /> NORTH(N). Ch � 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m (� o <br /> CENTERLINE OF ROAD, (C)BUILDING(S) MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF r z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. I ° <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. I <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 � o t <br /> MUST BE SIGNED AND DATED BY THE OWNER. o r <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN � <br /> NEEDED. Z ` O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o 511 <br /> CONDITIONS OF PERMIT: <br /> 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. J (� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY v <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> - p i <br /> 5. MoV2 bact 4I -b qq'IYK ferpho Cana <br /> 2oaft * <br /> m <br /> 6. D kko 11 <br /> CD <br /> O =N C0 00 <br /> N y O 3 <br /> 7. <br /> 0, m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m d O <br /> ( 9 Y ) Y Y GjR � : c <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of n <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize CDM <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is in l7 <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m j <br /> authorized rson to have acc o the above described premises at any reasonable ' of ins ection. m n <br /> D <br /> > : <br /> n : <br /> SIGN HERE " a <br /> o <br /> _ <br /> signature of owner or <br /> ipg contractor) (date) D <br /> �-/ <br /> ZONING ADMIN ATOR I I I J con f JIIN 2C <br /> El U <br /> EA EA EA(A N <br /> O N C T W W N O <br /> O Ul O C11 (n (T O <br /> TOWNSHIP PERMITS MAY BE REQUIRED BURNETT COUNTY <br /> THIS PERI�IIIT SL�I�EX�PrI���N���Af FROM'DATE QF ISS <br /> �IUri <br /> G �� <br />