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Office of Zoning Administrator - o Z <br /> Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 M 9 <br /> J APPLICATION FOR LAND USE PERMITS - <br /> 1 -Y� 7Ydp <br /> a � <br /> OWNER �/ S TELEPHONE o <br /> m O <br /> MAILING ADDRESS 77 11116 ,r,r' <br /> ev CD <br /> PROPERTY ADDRESS -77,Q 9 / iGoS,D�'eT �✓� �" " �K�y <br /> UjI14C6 aF yei/axi i-0t, <br /> t',v r 8 qzk 1 <br /> LEGAL DESCRIPTION(see tax receipt) 'eerio /U 40 Tw 0 A4 <br /> c <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION O � <br /> TYPE OF PERMIT(S): S. <br /> S. <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ / /DT. <br /> STRUCTURE/ADDITION USE: ' + SN� L <br /> (Home/Cabin; Commercial Business,Bedroom, Deck,etc.) S11 <br /> m � <br /> io <br /> BUILDING CONTRACTOR: '2 <br /> 0 <br /> M <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. M <br /> O m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) -n <br /> n v Z <br /> n m � <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE N _o <br /> NORTH(N). m 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF z <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 DISTANCES TO U� <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 �. o <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> 0 1 <br /> NEEDED. <br /> Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ° <br /> CONDITIONS OF PERMIT: _ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> OF TREES AND VEGETAT <br /> 3. NO G2. ORADING VAL OR SHIORELAND NG ALTERATIONS ARE AILLOWED UNLESS SPECIFICALLY <br /> IS RESTRICTED ALONG LINE. <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. /n�,, J _ <br /> 5. !'� X I Q'-Fir ���� j ��l/C�C�S 17� s U1 m uni d 0 0 g:$ r�rl <br /> �. IDC <br /> vnom^ � 3 <br /> T o' m <br /> Y mac : C <br /> I declare that this application (including any accompanying schedule) has been examined b me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy e e m a o m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize <br /> CD <br /> v <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information <br /> I am <br /> providing in this application. I agree to permit county officials charged with administerin c ns ection. T m o <br /> authorized person to have access to the above described premises at any reasonabl �t P - <br /> d : <br /> d vi a <br /> SIGN HERE .11A 2 ) <br /> ( <br /> gnat a of owner ui ng contractor) MAY J ^ <br /> ZONING ADMINISTRATOR <br /> BURNETT COUNTY q <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING C� <br />