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Burnett County 7410 Co.Rd. K, No.102,Siren,WI 54872 Office of Zoning Administ ator v Oz <br /> APPLICATION FOR LAND USE PERMITS ; <br /> _ r <br /> N 0 <br /> G G C <br /> OWNER L) t r ` a L ) n TELEPHONE <br /> MAILINGADDRESS O In <br /> TI r m <br /> I^ <br /> PROPERTYADDRESS V Y LV , <br /> of 0 0 Io f / --Q m V a 3 SPS C'S O C <br /> LEGAL DESCRIPTION(sea tax receipt) i!a r 3 7 CI-S Ir) GAS- J b <br /> S/ <br /> DWELLING/BUILDING ❑ GARAGEfACCE550RY STRUCTURE ❑ ADDITION ❑ y <br /> TYPE OF PERMIT(S): g _ <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTUREfAODn'ION USE: SIrk <br /> 1 o' <br /> (Home`/C/abin;Commerci Bu{si�n�essy; Bedroomec etc.) N <br /> XJ <br /> BUILDING CONTRACTOR: y" .5 <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/.%71 SHEET OF PAPER. ANY INCOMPLETE OR � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. OT — <br /> A H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> T n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 0 d A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND I NDIATE m <br /> NORTH(N). C ., 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) O m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM 10 Q� ' <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCEE T <br /> BUILDINGS,ROADS,LAKE,LOT LINES. i O <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.,TI,E F LANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. m c <br /> o r <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE NHEN <br /> NEEDED. n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT � I <br /> ISSUANCE. J <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. p <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY p <br /> PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> A mOr DO DOro <br /> 6. i4 'n£ m <br /> m <br /> I declare that this application(including any accompanying schedule) has been examinedEmend to the st f my —^ ' :» A knowledge and belief it is true,correct and complete. 1 acknowledge that I am recponsibleetail and a cu cy ofall Information contained in this application(including any accompanying schedule)and 1 fclare that I ee nize m 6 : m <br /> that this Information I am providing will be rolled upon by the County of Burnett Wisconsinmining wh he to is-sue a permit. I further accept all IIabllity which may be a rosult Of the County of BurneN rethis Inform tlo 1 amrovidin In this a licatlon. I a ree to ermit count officials char ed with administerinordinance o otherP 9 PP 9 P Y g authorized person to have accea to the above t1scribed premises at any reasonable time rpose of i spe lion. <br /> I m i D <br /> SIGNHERE — W i g <br /> slanatun of (err orr bulllldine,contractor) (este) 10 <br /> ZONING ADMINISTRATOR r lW `( ((';I ! ? <br /> S N N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> T IS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF I SUA CE <br /> Zflirn -I r Ir f 1W Masw 1-0 W411'1taL K - �.Q <br />