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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator '0 o° o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> VT <br /> N <br /> , 1 <br /> OWNER -/-.,4A) 0 A,,& fn 1(.D/,L/ TELEPHONE <br /> O <br /> / � IIO� <br /> MAILING ADDRESS <br /> PROPERTYADDRESSd4� <br /> LEGAL DESCRIPTION(see tax receipt) �G — <br /> �. <br /> 1q� . <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE 1:1 ADDITION 1C4 rn 0 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING IT 6DIVISION ❑ <br /> a <br /> STRUCTUREIADDITION USE: C � �/AJ ' /� �` y0. <br /> (Home/Cabin; Commercial Business; Bedroom, Deck;etc.) rn <br /> W r) <br /> QNTRACTOR: <br /> d � <br /> A PLO UST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> o NC <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> TI <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> 03 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m - <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF W 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 /> 6. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 1 <br /> 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 /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 <br /> NEEDED. eCv-a1j-vq <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> 0 <br /> CONDITIONS OF PERMIT: <br /> 1 � <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 1, <br /> SETBACK AREA. N <br /> 5. <br /> ;0 ()r DODO -0 <br /> M m � 00m E m <br /> 6. m 3 o. m O- <br /> -5 CDCWW6- f3 <br /> 7. Z -0 M0 <br /> O -n K ; �l <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of mya <br /> — A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of d 0 c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize V1 m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <br /> GY € <br /> sue a permit. I further accept all liability which may be a result of the Count of Burnett relying on this information 1 am d <br /> Pe P ty Y Y Y 9 (al <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to hayMccesUo top above described premises at any reasonable time for the purpose of inspection. m o <br /> CD <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) <br /> f <br /> ZONING ADMINISTRATOR ) <br /> ern : <br /> v N Ln <br /> O N0NN U1 OI <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> �',g "� <br />