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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator v G) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> OWNER,4,VA /e/�s TELEPHONE i&/-5/3 7-Z/7 3�' o <br /> MP ILING ADDRESS 7,3..5 ZZ ST /5`�.ttoJei✓ �it/ a 31 <br /> r m <br /> o <br /> PROPERTY ADDRESS o'1SD yy !9t/;ecrl , cSlrgeA) 1�61%o,* 7� I <br /> LEGAL DESCRIPTION(see tax receipt) 03 <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ dD©MoN ❑ __l/,., y o <br /> TYPE OF PERMIT(S): � yy,.��__44�� - - J C <br /> FILLINGfGRADINcaryl CAMPING UNIT ❑ SUB DIV Cr <br /> SION ❑ <br /> STRUCTURE/ADDITIONOSE: �� III! d I Gt.[.l�n V) <br /> (Home/Cabin; Commercial Business; Bedro ; Deck;etc.) y <br /> BUILDING CONTRACTOR: Set '- <br /> d <br /> v <br /> CD <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. T <br /> O ^ <br /> CA <br /> M UT <br /> a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) Om <br /> m a <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 5 p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m �? <br /> NORTH(N). a 0-�' <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 P <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 /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADEDOR ILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRA TC., THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. O <br /> \1 :E <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICAT ON MAY EN o <br /> NEEDED. � � (r ci <br /> THIS PERMIT IS CONDITIONS OF <br /> Ir <br /> S EBRM TT TO ALL CONDITIONS LISTED BELOW. evQh,I-n�2 A �nt o ^ Ll <br /> SL <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT'T,zoo ' CT0Up(,fJ <br /> ISSUANCE. AVN Mj y <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. G <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 /> �J m m r evaa * <br /> f m <br /> s. $ 3 ncOD s M <br /> 'O ry C <br /> 7. o m <br /> T m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> CL <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that 1 recognize m o : m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m O <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to ave access to the abo a described premises at any reasonable time for the purpose of inspection. fD o <br /> Q <br /> SIGN HERE <br /> ( na re of owner or bu ding contractor) (date) (� a <br /> is <br /> ZONING ADMINISTRATOR <br /> vs en <br /> Ul M0 0 <br /> M <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />