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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator v 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> �/ c <br /> OWNER /Y / / 16— / //�� n <br /> -I y TELEPHONE /%3' G a h/ / <br /> / <br /> MAILING ADDRESS Sic, r Gt M ( D O <br /> " //V n <br /> PROPERTYADDRESS � �°" <br /> vLEGAL DESCRIPTION(see tax receipt) "OT3 CSm <br /> C <br /> �v m <br /> DWELLING/BUILDING GARAGE/ACCES RY STRUCTURE ADDITION ❑ .� 9 ('I] <br /> TYPE OF PERMIT(S): � � <br /> FILLING/GRADIN ❑ CAMPING UNIT SUBDIVISION ❑ a <br /> I(-39' <br /> STRUCTURE/ADDITION USE: I u V �Y)l I <br /> / H�omne/Cabin;C <br /> orrynercial BusJiness; Bedroom;Deck;etc.) <br /> BUILDING CONTRACTOR: <br /> 42 V, <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/r X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O 9 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) A m <br /> a <br /> n <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. MZ <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m o 30 <br /> NORTH(N). (_ <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m W 0� 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF a <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO P <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N .0) <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS 0 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 2 o (RJB <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> Ln <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z ( <br /> CONDITIONS OF PERMIT: 9 <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. r <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 /> 6 m W y D O D 0 m <br /> 3nmC" <br /> O N C q N 0 3 <br /> 7. Z N N O <br /> -n <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 m 0 v, c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m E o In <br /> that this information 1 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 00 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> jj <br /> authorized person <br /> /Ito have access to the above described premises at any reasonable time for the purpose of inspection. (n <br /> T O <br /> N N . <br /> SIGN HERE S a 4_10 a �, m <br /> (signature of ow r 'Iding contractor) (date) <br /> A date) <br /> ZONING ADMINISTRATOR <br /> CEA EA EA fA�N <br /> N N N N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED N <br />