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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator v C Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> 0 <br /> o <br /> c <br /> OWNERr✓1� ( L�.. w>!t +� r TELEPHONE r- a <br /> 11 <br /> MAILINGADDRESS Zq� yy f Lr/9c N R D p4N L,R � V� <br /> PROPERTYADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) p 6 �s e V f 3 Q z Z,3 (A/ <br /> / CD <br /> TYPE OF PERMIT(S): DWELLING/BUILDING ElGARAGE/ACCESSORY STRUCTURE 1:1ADDITION c <br /> FILLING/GRADING/r,Q�,+❑ CAMPING UNITT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: yI L.Y 1C O e /L/ 6 X 1 K> o rl) <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: /(y I'WE 110 S CCA <br /> m <br /> 1 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n 3 <br /> x y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T ? <br /> M <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE o <br /> M <br /> NORTH(N). N o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m \ v Ik <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. Z <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. �J <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS 0 Q <br /> MUST BE SIGNED AND DATED BY THE OWNER. o I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATIO <br /> NEEDED. EN !j o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: � 4610 1 <br /> 1 ISSUANCE.DRIVEWAY <br /> MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMI-Aif?, , O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. C <br /> 3 NO GRADING <br /> OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 20N�A,o�/1/Tr <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. U l V CD � y00aD0 � <br /> 3 n m cD D a m A <br /> 7. N C yyj N O j <br /> Z n m o <br /> = c : M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my — r» p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o� d, c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I 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 <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 p ,) C <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. (Do' <br /> rC �( m of <br /> SIGN HERE <br /> fn i m i <br /> (si ature of owner or building con (date) <br /> �- <br /> date) <br /> ZONING ADMINISTRATORa es <br /> TO SHIP PERMITS MAY BE REQUIRED J C ///�� -;?-3o o u o 0 <br /> GZk✓ Q <br />