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Burnett County 7410 Co. Rd. K, No.102,Siren,W154872 Office of Zoning Administrator -U o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> t � K 715-311-sa l cz N o <br /> N <br /> OWNER _r 1 (, TELEPHONE l W <br /> CD <br /> / `�Co! /U o <br /> MAILING ADDRESS f <br /> L <br /> PROPERTY ADDRESS -S- c LC ~ <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING <br /> ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION <br /> TYPE OF PERMIT(S): Q C\ <br /> FILLING/GRADING 4 CAMPING UNIT ❑ SUBDIVISION ❑ �' "( <br /> ti 5 \. <br /> STRUCTURE/ADDITION USE: A 41t71U �� y9 f�t=o ° <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) cn <br /> BUILDING CONTRACTOR: <br /> m <br /> ID <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. p <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 U O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 R- <br /> 2. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). Cn3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO Im <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. OQi P <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO d <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <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. F <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHENco 0 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o O <br /> CONDITIONS OF PERMIT: O <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. ._ <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 /> Cc� � > Cnvv <br /> 0 jm = � `Ox <br /> 6. co X3 a m �c <br /> O N C <br /> 7. <br /> Z C y N O <br /> m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m _ t^ A <br /> PP ( 9 Y ) Y Y C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of f m 0_ <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize \ m mo <br /> CD <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- J; rn <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 v o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person o ave ace to the ab a des ribed p the purpose of inspection. m 'a <br /> -n <br /> O <br /> N d <br /> SIGN HERE 6+ _n <br /> ( ignatur ow o buildin ntractor) (date) � yy� ' o <br /> • W i i <br /> ZONING ADMINISTRATOR �jlm Flant SEP 1 .l 2004 <br /> /y fA Vr lli N <br /> U O N W W N O <br /> TOWNSHIP PERMITS%Af*-1iE& Ty <br /> THIS PERMIT SHALL EXPIRE ONE YEAR 4TE OF ISSUANCE <br />