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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator v 0Z <br /> APPLICATION FOR LAND USE PERMITS 3. 0� <br /> r <br /> CDN � <br /> N G� <br /> OWNER ELEPFONfftwQOG � nIV q511 <br /> a `_ <br /> MAILING ADDRESS2;�7 g 3 oq t..auyrY RO FF WPk,,/IUPC / S093 / n r <br /> Udo <br /> PROPERTYADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) L�f Jm uo/ S L- I U) <br /> �� oCD <br /> JI / ti <br /> DWELLING/BUILDING 11GARAGE/ACCESSORY STRUCTURE ADDITION ❑ m <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CA PING UNIT ❑ SUBDIVISION ❑ <br /> a <br /> STRUCTUREIADDITIONUSE: S <br /> abin; Comm rcial Business; Bedroom; Deck;etc.) y <br /> BUILDING CONTRACTOR: <br /> .�' <br /> Q 1 <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 6'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> O <br /> N Q <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n 00 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m I B <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 1 "� Z <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 GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. a <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P ) <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. Ck <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER C <br /> SETBACK <br /> —AREA <br /> 5. . <br /> X m°r' 0ma � m <br /> 6. m 3cl@0M LL <br /> m <br /> O m Cy m p 3 <br /> 7. Z v ,po � o <br /> O T 2 rn <br /> iI <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my n cj A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of Y✓ @ <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- v <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 oO, <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person ave acces t above escribed premises at any reasonable time for the purpose of inspection. m ° o <br /> -7 m m <br /> SIGN HERE <br /> (sl g f o ner or b ' g actor) (date) a <br /> ZONING ADMINISTRATOR <br /> LIMv, <br /> cNi o 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />