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Burnett County 7410 Co.Rd.K, No. 102,Siren,WI 54872 Office of Zp�Wl i Administrator o <br /> APPLICATION FOR LAND USE PERMITS"" �OMPUTER/S q Ebj <br /> r <br /> OV*4ER it.,C_ e TELEPHoN�.2" t/i t Sr, <br /> n T m IN <br /> MAILING ADDRESS b r_ <br /> PROPERTY ADDRESS -Z 7 3, 2 L o L <br /> LEGAL DESCRIPTION(see tax receipt) <br /> � m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ m o <br /> TYPE OF PERMIT(S): � <br /> FILLING/G DING ❑ CAMPING UNIT ❑ SUBDIVISION ISION -1010I / FL <br /> STRUCTURE/ADDMON USE: R t i is V A/p i n rk t g T i r7 f�f c Ir � ' ��(� w <br /> o' <br /> y�e (HomGj 'Comme(cial Business;Bedroom; De ;etc.) m <br /> BUILDING CONTRACTOR: 3 <br /> a�Id cue C"Ir }Fri - <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/,X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. Om 3 <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING /M <br /> (AERIAL OR TOP VIEW) <br /> Tn <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 7! Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m X <br /> NORTH(N). m n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OFU�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 o <br /> BUILDINGS,ROADS,LAKE,LOT LINES. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER, CONTRACTOR, EN <br /> TC.,THE PLANS � I <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> 40 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o� <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z .. / <br /> CONDITIONS OF PERMIT: Ptj <br /> `J <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 <br /> PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. o m m A d n <br /> $ 3c$ ' a _ � <br /> 7. a m C <br /> Z a o c <br /> P zil`2 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my fn <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that 1 am res y 2 i i i C <br /> responsible for the detail and accuracy of ; m o ; 40 <br /> all Information contained in this application(including any accompanying schedule)and 1 further declare that I recognize o' o m <br /> that this information I 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 I am m <br /> providing In this application. 1 agree to permit county officials charged with administering county ordinances or other d <br /> authorized pe on to have access to the above described premises at any reasonable time for the purpose of inspection. i o i <br /> - o <br /> SIGN HE / 03 <br /> signature of ow ne r building contractor) (dam) '• : a <br /> ZONING ADMINISTRATOR <br /> aH <br /> M N+ N <br /> NN O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED N 00 0 <br />