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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of ZoningAdministrator <br /> CD 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3 - <br /> 5 0 <br /> `D <br /> OWNER TELEPHONE <br /> C p 7 ,-7- /q �.•2_ 7 lS=��� 7 �3 <br /> 0 <br /> W <br /> MAI LI NG ADDRESS I � � � ��T s'7— � !/ CE)� O <br /> 70 � <br /> r � <br /> o <br /> PROPERTY ADDRESS Lp �/�S !l �Ta�,�, �� Cf, <br /> LEGAL DESCRIPTION(see tax receipt) A <br /> CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITIONo <br /> TYPE OF PERMIT(S): C :3c <br /> FILLING/GRADING El CAMPING UNIT El SUBDIVISION ❑ Cr <br /> CL <br /> STRUCTURE/ADDITION USE: C_ <br /> o' <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) -� <br /> su <br /> BUILDING CONTRACTOR: --� <br /> -v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR o <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p C <br /> 'n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> n _� z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m o <br /> NORTH(N). C 0 <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 <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. - t___ Z <br /> LeN <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO <br /> --5� o <br /> BUILDINGS, ROADS, LAKE, LOT LINES. 1 <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 0 <br /> C>P <br /> MUST BE SIGNED AND DATED BY THE OWNER. Z 0 1 <br /> 0 J <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o Q> <br /> NEEDED. 0. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o t <br /> CONDITIONS OF PERMIT. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Q, i <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 /> see � <br /> F/Iott' (�e <br /> X a) 0 DODO 'D <br /> 00 CD ,3 3 a o cD <br /> crn <br /> 7. `n � �• � <br /> Z Cn W `QCD CD <br /> dapplication <br /> o m -n <br /> declare that this a lication -' m <br /> pp (including any accompanying schedule) has been examined by me and to the best of my p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of 0) 0 v <br /> C C <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize � m <br /> PP (� 9 Y ) <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 relyingon this information I am ami o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other v m <br /> authorizq4 person to have access o the above described premises at any reasonable time for the purpose of inspection. CD <br /> -n a <br /> c� �-t--'t_ CD <br /> C <br />