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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v O Z <br /> APPLICATION FOR LAND USE PERMITS 3 g <br /> r T' <br /> io 0 1\1 <br /> OWNER S60 C,e— TELEPHONE 63S' 390 1 O <br /> m <br /> ^ O <br /> MAILINGADa <br /> DRESS q (_On2 t ���e, <br /> r m <br /> PROPERTY ADDRESS S A*VLQ <br /> LEGAL DESCRIPTION(see tax receipt) es-wt U. (6 P.7Z sed, , q Tyo IUR/c(u� O <br /> 7c A <br /> DWELLING/BUILDING ❑ GARAGEIACCESSORY STRUCTURE ADDITION 1:1V to <br /> TYPE �- <br /> OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> /! � �� II � N <br /> STRUCTURE/ADDITION USE: ntk r`wA+-t M Lfkk'G <br /> (Home/Cabin; mercial Business; Bedroom; Deck; etc.) Co <br /> BUILDING CONTRACTOR: <br /> n . <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN SY,X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O y <br /> M y s <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> -n o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 0 1 <br /> NORTH(N). a <br /> O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(8) 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 �l <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 n y <br /> MUST BE SIGNED AND DATED BY THE OWNER. Ot ro <br /> '— <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN /" o <br /> NEEDED. n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. P ^A <br /> CONDITIONS OF PERMIT: PO W <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT (� J <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. T" <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 W� >O a l7 3 <br /> 6. m x3 am `9: A <br /> 0 om 0 3 <br /> 7. Z <br /> m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m °i ' A <br /> PP (� 9 Y ) Y Y <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of pQ� [ d n G . C <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize m ci I 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 1 am I m : o <br /> providing in this application. 1 agree to per n count officials barged with administering county ordinances or other <br /> authorized person to have access to the ve e s at any reasonable time for the purpose of inspection. m <br /> D <br /> SIGN HERE <br /> (siafar of ow r building contractor) (date) �j��J;. 0 <br /> ZONING ADMINISTRATOR <br /> w win <br /> TOWNSHIP PERMITS MAY BE REQUIRED O o u o N v o <br /> HIS PERMIT SHAL E PIRE ONE YEAR M DATE OF ISSUANCE <br /> F O <br /> Zro ,�+ l�� cr �('l� scotf7�c� -a1-D6 <br />