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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. `\ , <br /> N <br /> N <br /> L' SSC ' n <br /> OWNER Cy to CQf,`C� 3'�N TELEPHONE -71b- 7- 39 v <br /> A� 00 <br /> f Z <br /> MAILINGADDRESS q0 5 -10 Weil WT Sy <br /> ` f o m <br /> PROPERTY ADDRESS qqo Cy -70 1 <br /> LEGAL DESCRIPTION(see tax receipt) � <br /> m <br /> IIS�II <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE JAI ADDITION ❑ cn <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING 11 CAMPING UNIT ❑ SUBDIVISION <br /> STRUCTURE/ADDITIONUSE: /Gkomu 564' to'l w5cdlu-❑44 o <br /> 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) rn <br /> BUILDING CONTRACTOR: <br /> Nle <br /> T <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. m <br /> y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> _n <br /> t. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m !° <br /> NORTH(N). <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <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. 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 /> S. 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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o 0 <br /> v � � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT v 1 <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 /> j'�j <br /> 5 SETBACK AREA. S vem, n � ���Q� q ��U� Uy!% /"— "` <br /> 6. m d m '0 � aE m <br /> OD/ 3 n F a <br /> 7. T <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my _ r^ A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d 1 in c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m C v <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 Burn lying on this information I am 00 <br /> providing in this application. I agree to permit county officials c county ordinances or other o <br /> authorized person to have access to the above described premise r the purpose of inspection. r CD <br /> (D o : <br /> M m <br /> SIGN HERE <br /> CL <br /> (signature of ow orb ' n ate) <br /> ZONING ADMINISTRATOR QRZ <br /> 13, 1�J fA fA EA di N <br /> J cn Otn tn00 <br /> TO SHIP PERMITS MAY BE RE <br />