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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. <br /> N <br /> C <br /> OWNER �p t { w3czry GL'c�C I er TELEPHONE <br /> MAILINGADDRESS ��'d� � t- V�e�/ (��Q SV91 0 <br /> nn <br /> PROPERTY ADDRESS a ��58 L u iew X <br /> / <br /> LEGAL DESCRIPTION(see tax receipt) <br /> O m <br /> DWELLING/BUILDING GARAGEIACCESSORY STRUCTUREX ADDITION ❑ <br /> TYPE OF PERMIT(S): C � <br /> a <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: PA-1L 'F <br /> i (Home/Cabin; ommercial Business;Bedroom; Deck;etc.) co <br /> BUILDING CONTRACTOR: SSPd r <br /> m <br /> Z � <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 17 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> :0m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> -n n <br /> t. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> m o <br /> NORTH(N). C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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. c <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 GRADED OR FILLED. 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 <br /> v, <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN $p g <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o I <br /> CONDITIONS OF PERMIT: (� D <br /> N W <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 C <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. C .K-K. "i n �Is C` id aJ Q't <br /> We (�7ZS-i� �dltl"ld « 7/ ��C7 <br /> 6.71;/ m W W. n Mo a f m <br /> 8 3 x = M <br /> 0 C y y 0 <br /> 7. Z H O O to <br /> O n� it <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �j O <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d rfl C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize „C m � o mt7 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- i (D <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 d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. fD <br /> -n O <br /> ry N <br /> SIGN HERE 46-6=2743 n <br /> (signature o er or building con c r) —� date o. <br /> ZONING ADMINISTRATOR ) <br /> 1A bN fA 1.9-N <br /> ro (T N N O O <br /> (r O N(T O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />